Q. I have fibromyalgia and have gained nearly 40 pounds over the past 18 months despite the fact that I eat a balanced, calorie-controlled diet. My doctors attribute my weight gain to the fact I stopped smoking—baloney. What can I do to lose weight that doesn't increase my pain?
A. For those who aren't aware, fibromyalgia is a rheumatoid-like condition that results in chronic pain and severely-tender points on the body that can drastically limit one's ability to be physically active. Associated symptoms can include overall fatigue, poor sleep and depression. The pain of fibromyalgia often contributes to a sedentary lifestyle. A person with this condition may limit activity as much as someone with rheumatoid arthritis does.
There are many reasons for weight gain, and while stopping smoking may result in a few pounds gained, there are other probable causes such as inactivity and overeating. Also some medications, including some used to treat depression and hormonal changes or imbalances, can also lead to weight gain.
So, given your physical limitations, how do you shed the fat? Excess weight and body fat loss is usually best achieved through a combination of eating less and moving more. Dieting alone can produce weight loss, but research shows that muscle mass is preserved when exercise, particularly weight lifting, is performed while dieting. And exercise is a must when it comes to maintaining weight loss.
You say you eat a balanced diet. However, sometimes extra calories sneak in and you may actually be eating more than you think. Keeping a food log is a good way to gauge how much you eat. I explain how here, or you can find a variety of apps for your smart phone that make tracking a little easier.
What may also help tip the body-fat scale is burning more calories and building up more muscle through exercise. Several reviews have tried to assess how exercise affects fibromyalgia, although they have focused mainly on how it can benefit the symptoms of the disease like pain and physical functioning, rather than weight loss or body composition changes.
A 2006 review looked at 46 experimental studies that evaluated aerobic exercise, resistance training and stretching, either on their own or in combination workouts. A variety of different types, intensities and doses of exercise were used. Overall aerobic exercise seemed to improve the symptoms of pain, fatigue, poor sleep and depressed mood. Strength and flexibility training were also found to improve symptoms, although there were not enough studies to conclusively suggest a specific prescription.
Another review in 2008, published in the Journal of Rheumatology looked at 34 studies and found that aerobic training provides benefits such as improvements in physical function and, possibly, pain. There was limited evidence that strength training improves pain, global well-being and physical function, and not enough evidence to determine the effects of flexibility training. A 2010 review in the journal Rheumatology International looked exclusively at the effects of aerobic exercise and found that there is moderate evidence that it can improve physical function and possibly tender points and pain.
Getting exercise is part of the general treatment recommendation for fibromyalgia suffers. If you can do it, it should help not only the symptoms of fibromyalgia, but also with weight management.
So what should you do? An ideal prescription specifically for fibromyalgia has not yet been determined. The studies reviewed used a variety of different exercise types, intensities and doses, generally following the official guidelines. Most studies reviewed had subjects participating in an hour-long exercise session two or three times per week and within that time they were doing some form of cardio, such as walking, water exercise or riding a stationary bike for at least 20 or 30 minutes. However, those who experienced pain modified their movements or lessened their activity as needed.
For weight loss, the more calories you can burn the better. Higher intensities workouts tend to burn more calories in a given amount of time, but the 2006 review noted that while higher intensities of exercise did produce greater fitness benefits, as would be expected, those with fibromyalgia were more likely to stick to lower intensities of exercise, and experience less pain by working out a little more lightly. You can still accrue a good calorie burn from lower intensity workouts; you just need to exercise for a little longer. Or if that is uncomfortable, break up the activity periods throughout the day.
Anyone beginning to exercise should always start easy and work up gradually. If pain arises, recommendations are to modify the workout to decrease the pain (go slower, for example), but to keep up the frequency of the exercise. Researchers at the Oregon Health & Science University recommend that those with fibromyalgia structure an exercise session by beginning with deep breathing and muscle relaxation, followed by gentle movements that increase range of motion (such as arm reaches), followed by stretching, then resistance training, and finally aerobic exercise.
Give yourself a good six months to one year of regular exercise to achieve a lower body weight. If your pain limits you, you may have to take it a little slower. Along with controlling your weight, you will get fitter and stronger, and you possibly can improve the painful symptoms of fibromyalgia.
