It is important to stress a graded approach to exercise. In practice and in research it has been demonstrated that moderate cardiovascular exercise improves both pain and fatigue; however, intense exercise make them worse.  Patients must be cautioned to start off very gradually at a level that will not increase their pain. This may be a little as a minute or two at a time in the beginning. Many patients are too aggressive in the beginning and exercise to a level that increases their pain. These patients often give up on exercise as a treatment option and take an increasingly passive approach to their care. The message must be that a little exercise will make you better and too much will make you worse. The amount of exercise at which a patient feels successful is the goal.

Exercise and fibromyalgia might seem like an odd couple. When you have widespread chronic pain, it's easy to see why you may not want to spend hours at the gym. Just the thought of exercise can conjure up some pretty intense imagery (ie, daunting treadmills and cold, heavy barbells).

But any way you look at it, exercise is an essential part of managing your fibromyalgia symptoms. Some specific benefits for fibromyalgia sufferers are:

• It strengthens your muscles. Muscles that are lean, flexible, and strong combat stress. Strong muscles also support your body and bones better, which aid movement and support.
• It increases energy. People with fibromyalgia often experience debilitating fatigue, and regular physical activity can help boost energy and endurance levels.
• It promotes a restful sleep. Research shows that exercise helps you fall asleep and stay asleep longer. Sleep disorders are a common fibromyalgia symptom—one that exacerbates the disorder's widespread pain. Better sleep can mean less pain.
• It's good for your mental health. Exercise reduces stress, anxiety, and depression—all common symptoms associated with fibromyalgia.
• It keeps the weight off. The more weight you carry, the more stress it puts on your body, causing pain. Exercise, along with a balanced diet, will help you reach or maintain a healthy weight.

Where to Start: Exercising with Fibromyalgia
The first step is having a realistic look at exercise. You don't have to spend hours at the gym, and your work outs need not be mini boot camp sessions. You can improve your fitness, and thereby strengthen your back to combat your fibromyalgia pain, with some simple stretching, aerobic, and strength exercises that don't require much time—3-4 days a week for 30-40 minutes each session are the widely accepted guidelines.

It's important to know that progression is key to the success of any fitness regimen. For example, don't jump into strength training without first mastering a stretching and aerobic program. If you don't start slow, you may end up causing more harm than good.

What Exercise Can Do
Start by engaging in a daily stretching program to lengthen tight muscles and promote flexibility. Your doctor may recommend adding in forms of cardiovascular exercise, such as walking or swimming.

When you feel comfortable, you may want to enroll in an aerobics class or supplement your cardiovascular routine with strength training. Yoga and Pilates may be good strength training options, as they use your own body weight for resistance.

Talk to your doctor or physical therapist about what exercises will best suit you. You'll need to take your pain and fitness levels into account, and you'll want to tell your doctor what activities you most enjoy to increase the odds that you'll stick with the program. Together, you'll develop an exercise regimen that will help you manage your fibromyalgia symptoms and give you a better quality of life.