Magazine Article Published in: IDEA Personal Trainer

Remember the last time you had the flu? The fatigue, aches and pains, nausea . . . . Now imagine exercising when you feel like that. 

That is exactly what a client with fibromyalgia syndrome (FMS) feels like on a regular basis. Fibromyalgia is a painful condition of the soft tissues, mainly the muscles. It causes widespread pain, stiffness, fatigue and poor sleep patterns. These symptoms may go into remission for a while, but they usually return, though they don't increase in severity. 

If you have clients with FMS, you need to understand that their capabilities and needs are different from those of other clients. Having been diagnosed with FMS myself four years ago, and having trained clients with FMS for the past two years, I have learned a few things about the effects of the disease on exercise--and vice versa. 

People with FMS must learn to accommodate discomfort in their daily lives, especially when they're adjusting to a fitness routine. FMS clients are likely to experience some discomfort, somewhere on their bodies, most of the time. This is one case when the phrase "if it hurts, don't do it" doesn't apply--although you do want to make sure exercise doesn't exacerbate a client's pain. 

Before starting a training program with a client with FMS, find out the client's experience with exercise prior to the appearance of the disease. This knowledge will help you formulate an individualized exercise routine. A client who was sedentary before the diagnosis will, of course, need to start a program even more slowly than a client who was formerly a regular exerciser. To make sure the exercise program is safe, be sure to consult with the physician who diagnosed the disease and is treating the client for it. 

Take a good look at the client's posture. In an attempt to alleviate the discomfort associated with FMS, individuals may develop rounded shoulders, swayback and a tendency to lean forward. This unnatural posture increases stress on the body. Focus on proper body alignment from the beginning of the program. 

For each individual with FMS, the pain is focused in particular areas of the body. The locations will be different for each person. I usually experience pain in my left shoulder girdle and right hip. 

When designing a strength training program for these clients, start with very light weights. Sometimes just doing the exercise without any weight is a sufficient start. For the painful areas, try various exercises to see which are best. One exercise may aggravate the pain, whereas others won't. For example, I can do lat pull-downs with light weights, but one arm dumbbell rows cause too much pain. For the unaffected areas of the body, you should also start lightly and progress slowly. The client's recovery time will indicate how to proceed. Your client should be fully recovered from the workout in two to three days. If not, back off on the weights and/or repetitions. Strength training is recommended only twice a week, with a minimum of three recovery days between sessions. 

For cardiovascular conditioning, walking appears to work best for most people with FMS. If a client's pain is focused in the feet, however, try a stationary bike. 

Flexibility training is a key element of a program for these clients. I spend a minimum of 15 minutes having them stretch after their workouts. I also encourage them to take "stretch breaks" at least three times a day, focusing on the aggravated areas. When they walk, I have them stop after a few minutes and stretch their rotators, iliotibial bands and anything else that feels tight. Then they continue to monitor their bodies and stop to stretch if they feel any tightness or pain. Yoga has worked wonders for me, so I encourage my clients to enroll in a "gentle yoga" class. 

One of your biggest challenges with these clients will be dealing with the emotional aspects of the disease. People with FMS often experience a lot of fear, anger, frustration and resentment about being diagnosed with an illness that will not go away. They have pain even before they exercise, and they fear exercise will only make it worse. You may often hear, "I can't do that."

If you have clients with FMS, keep the following points in mind:

• Start slowly and allow clients to learn their capabilities.
• Be patient--and help your clients learn patience too. Exercise progression will be different than with your healthy clients.
• Cultivate a positive attitude. Be quick to point out--and reinforce--the improvements clients make, no matter how small they may be. Remember, progress is made even with baby steps.

By KIM WILLIAMS-BRINCK

Kim Williams-Brinck, owner of Physically Focused, is certified by ACSM and ACE. She has been a personal trainer for five years at the time of publication.