Exercise is highly recommended as an adjunct therapy for fibromyalgia. We’re not talking about pounding the pavement, however.

tired young woman

Intense aerobic exercise is not recommended for fibromyalgia

A 2010 review of exercise studies found that ‘slight to moderate’ intensity aerobic exercise sessions done two to three times a week worked best, and that appropriate levels of exercise result in improved fitness but only modestly improved pain. Another review that warned not to overdo exercise stated that “the latest findings…. indicate the fundamental importance of assigning workloads (i.e. exercise) that do not exacerbate post-exercise pain.”

Something is preventing many FM patients and almost all ME/CFS patients from participating in intense exercise. Four studies suggest that that “something” in ME/CFS involves a damaged aerobic energy production process.

Health Rising hasn’t covered exercise in FM before, but guess what? Some FM studies suggest the aerobic energy production system doesn’t appear to be doing well at all.

Déjà vu All Over Again? The Fibromyalgia Exercise Studies

Several FM studies have found problems with exercise. A 2013 study found reduced oxygen consumption during a submaximal and a maximal exercise test.  A 2011 finding of reduced oxygen consumption (VO2 max), reduced heart rates during exercise, and delayed heart rate recovery suggested a familiar pattern of autonomic nervous dysfunction (increased sympathetic nervous system activation/decreased parasympathetic nervous system activity) was responsible.

The authors pointed out that 57% of FM patients met the criteria for chronotropic incompetence (an inability to get the heart up to speed during exercise). SImilar findings have shown up in ME/CFS.


Defying expectations, the stress response is on at rest in FM (and ME/CFS) and then poops out when stressful situations occur

The authors also noted that FM patients demonstrate ‘sustained sympathetic hyperactivity’ during rest (the stress response is on during rest), and a hypoactive or poor response to stress. This suggests that the stress response in FM is “on” when it should be “off”(at rest), and then tends to poop out when faced with work (such as intense exercise). A similar pattern has shown up in ME/CFS and interestingly, lupus.

A 2002 study finding of reduced oxygen uptake (VO2 max), ventilatory anaerobic threshold, and heart rate during a maximal exercise test in FM again suggested problems with aerobic energy production were present.  These authors proposed that dysregulation of the autonomic nervous system (dysautonomia)  were responsible. They also noted that resistance training can improve some aspects of autonomic nervous system functioning.

These findings suggest that whatever the differences in their ability to exercise, FM and ME/CFS patients have similar problems with aerobic energy production and autonomic dysfunction.

The Study

Pain severity is associated with muscle strength and peak oxygen uptake in adults with fibromyalgia. Hooten WM, Smith JM, Eldrige JS, Olsen DA, Mauck WD, Moeschler SM. J Pain Res. 2014 May 3;7:237-42. doi: 10.2147/JPR.S61312. eCollection 2014.

These researchers wanted to know if reduced aerobic energy production (low VO2 max) was associated with reduced strength and increased pain in FM. They had their fibromyalgia patients exercise to exhaustion while measuring their oxygen uptake and then did a separate muscle strength test.

It turned out that the FM patients with reduced aerobic energy production were significantly weaker and in more pain than FM patients exhibiting higher levels of aerobic energy production.

Simply being in pain can inhibit muscle recruitment - making you weaker.

Simply being in pain can inhibit muscle recruitment – making you weaker.

The Triad: Energy Production, Strength and Pain

What’s causing this energy production-pain association? Studies have illuminated several possibilities.

  • Pain – Simply the presence of pain could be reducing the muscle contraction needed to exercise properly. It turns out that activated pain receptors in the joints tell the motor neurons in the brain not to turn on the muscles. Even the anticipation of pain can reduce the efficiency of motor neuron activity. (An April 2014 study indicating that trigger point injections increased handgrip strength in women with FM and/or myofascial pain syndrome suggested pain may reduce strength. )
  • Reduced Muscle Recruitment / Motor Cortex Dysfunction –  Some research suggests normal muscle recruitment is not occurring in FM. Because stimulating the same muscle unit, again and again, puts it into a contracted painful state, more and more muscle units need to become activated for exercise to continue.  Reduced muscle recruitment, then, could contribute to the painful, contracted feeling FM patients often experience.
  • Reduced Blood Flows – Blood flows are critical not just to meet the oxygen demands of exercising tissues but to remove the toxins created during exercise. The reduced capillary density and blood flows found in FM could make it difficult to remove those toxins. At least as early as 2006, researchers suggested that muscle ischemia (low blood flows) both during and after exercise could be causing pain in FM and driving the central sensitization found. Problems with the microcirculation could, therefore, contribute to the aerobic energy problems, pain, and weakness in FM.

Bad Motor? Are ME/CFS, Fibromyalgia and Long COVID all Motor Cortex Diseases?

The authors argued that the next step is to determine what happens to capillary blood flows during exercise. Given the overlap in both exercise and muscle study results in ME/CFS and FM, those results could apply to ME/CFS.

This study also suggests finding an appropriate exercise regimen could be helpful. FM studies suggest that greater muscle strength is associated with better mental and emotional well-being and reduced oxidative stress.

Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia

An interesting jumble of energy production and muscle problems have shown up in ME/CFS and FM.

Low blood volume – potentially a critical factor in getting blood to the tissues – is acknowledged in ME/CFS but is hardly considered in FM but perhaps should be given more study given the issues shown in this study.

The similar muscle and energy problems in ME/CFS and FM suggest a research collaboration could be helpful.

The similar muscle and energy problems in ME/CFS and FM suggest a research collaboration could be helpful.

Increased levels of oxidative stress, mitochondrial problems, muscle fiber issues, increased muscle levels of the toxins pyruvate and lactate, and reduced microcirculation in the muscles have all been found in FM.

Newton’s studies found poor pH handling and increased muscle acidosis in ME/CFS. Reduced muscle ATP production has also been found in ME/CFS. Studies suggest the muscles in both ME/CFS and FM patients suffer from reduced oxygen uptake.

A 2014 study finding normal blood flows but increased muscle and blood glutamate and lactic acid levels in people with chronic widespread muscle pain suggested normal blood flows may not be enough to remove the toxic byproducts produced.

The ME/CFS and FM fields remain stubbornly separate with few studies incorporating both types of patients. The energy production and muscle study results appear to be strikingly similar and findings from either disease could end up informing the other. With neither disorder getting much in the way of federal funding working together might be a good idea.

Your Donations Play a Vital Role in Keeping Health Rising on the Web





Like the blog you're reading? Don't miss another one.

Get the most in-depth information available on the latest ME/CFS and FM treatment and research findings by registering for Health Rising's free  ME/CFS and Fibromyalgia blog here.

Stay on Top of the News!

Subscribe To Health Rising’s Free Information on Chronic Fatigue Syndrome (ME/CFS), Fibromyalgia (FM), Long COVID and Related Diseases.

Thank you for signing up!

Pin It on Pinterest

Share This