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Fibromyalgia (FM) is a chronic disorder that is characterized by widespread musculoskeletal pain and other multisystemic symptoms. An estimated 2% to 5% of the population is diagnosed with FM, about 5 to 10 million people in the United States, making it the third most prevalent rheumatologic disorder in the United States. Although the disease affects both men and women, 80% of those affected are women between 20 and 55 years of age. (The occurrence of FM in young women can negatively affect their potential to pursue future career goals).

fibromyalgia practical approach


Recent approaches to a diagnosis of FM have shifted to use subjective scales:

  • the wide pain index (WPI) = number of pain areas (scores from 0-19)
  • the symptom severity scale (SS) = considers the severity of 3 symptoms (fatigue, waking unrefreshed, and cognitive symptoms)


There is no known cure for FM although the available approaches to treatment involve pharmacologic and nonpharmacologic interventions.

Nonpharmacologic treatment is a combination of education, stress reduction, and physical activity. However, recent research has shown that aerobic training can improve pain, function, and overall wellness. Still, many FM patients may hesitate to try physical activity for the fear that it might worsen their pain, thus increasing the tendency for individuals with FM to become sedentary and likely deconditioned.

Fibromyalgia – practical approach. Effects of exercise training:

Exercise training for individuals with FM was shown to elicit similar general health benefits as shown in healthy individuals. Yet, the exact dose of exercise training needed to improve FM symptoms is not readily available. With that being said, exercise training can, indeed, lead to an improvement in some of FM- related symptoms: decrease overall pain, reduce number of tender points, improve sleep, assist in rebuilding social interactions, and improve overall daily function.

Recommendations for exercise training programs:

The ACSM (American College of Sports Medicine) guidelines for individuals with FM recommend beginning with light-intensity activities (fewer than 3 days per week) and, ultimately, reaching a long-term goal of 150 min/week. The main goal is to restore and maintain physical functioning. Thus, it is suggested to start with low to moderate-intensity aerobic and no/low impact activities.


Walking and cycling activities are recommended.

Strength training:

Exercises should focus on the lower body – major muscles group: quads and hamstrings.

Warm-water aquatic programs/hydrotherapy:

This is a safe and effective intervention platform. Specifically, hydrotherapy was found to improve psychological symptoms, increase musculoskeletal strength, and is considered to be the most tolerable and favorable workout for people with FM pain. Accessibility and affordance are two major constraints involved in the recommendation of hydrotherapy care. However, those who manage to adhere to a 6-month water program surely enjoy the physiological, physical, and psychological benefits of it.

Yoga and Tai chi:

These exercise platforms are also shown to be beneficial, particularly if instructors are qualified in training for people with chronic pain conditions.

Activities such as yoga and tai chi are considered to be favored over other programs, like stretching and strength training.

Aquatic therapy programs in NYC:

  1. Metro Physical & Aquatic Therapy
  2. Aquatic Rehabilitation Center
  3. Aqua Health Rehabilitation Center
  4. Long Island Premier Physical & Aquatic Therapy
  5. MOTION Sports Medicine – Hutchinson Metro Center