1. CAWH Fibromyalgia Workshop: Non-drug Treatments Center for the Advancement of Womens Health University of Kentucky

2. Types of non-drug treatments Education Exercise Sleep hygiene Nutrition

3. Education This is why we are here! In research studies … improves symptoms and quality of life (often as well or better than drugs) Gives you control … Knowledge is power!

4. Exercise Why should I exercise? Because its good for you? Because we say so. Or rather, research says so. …exercise training has beneficial effects on physical capacity and FMS symptoms. Exercise for Treating Fibromyalgia Syndrome by Busch, et al. (2002) The Cochrane Library The optimal intervention for FM would include non-pharmacologic treatments, specifically exercise and cognitive behavioral therapy, in addition to appropriate medication and management for sleep and pain symptoms. A Meta-analysis of Fibromyalgia Treatment Interventions by Rossy, et al. (1999) Annals of Behavioral Medicine

5. No, really – why? Its the only free drug on the market No toxic effects BUT Doesnt work unless you do it Maximal therapeutic dose

6. Dose Response Therapeutic Range Therapeutic Dosing of Exercise Maximal tolerated dose

7. Why does it work? Theory of Thermogenics: heat and cold tolerance improve following exercise - anxiety reduction Endorphin Theory: natural opioids in the brain increase in response to some exercise activities Norepinephrine & Serotonin Theory: receptor sensitivity is enhanced; parasympathetic nervous system activity is enhanced - decreased depressive symptoms, anxiousness Cardiovascular Conditioning: Improves muscle microcirculation – which reduces damage Associated with Wellness

8. Your personal wellness What does it mean to you? What do you want? Is it realistic? Is it possible? Is it probable? Hmmm…

9. What is exercise? Pretty much anything that involves repetitive physical motion of large muscle groups Physical Activity Activities not necessarily associated with the pursuit of any physical fitness or health gains, accrued through regular day-to-day living Aerobic Exercise Walking Swimming/Water Aerobics Resistance exercise (strength training) Some aspects of physical therapy Pilates (only if cardio fit) Theraband exercises Flexibility Stretching, most forms of yoga

10. Just the facts No cure. Today, were not going to fix whats broken. The responsibility for feeling better and doing more is yours. Exercise and/or physical activity are an invaluable component of any worthwhile FM management approach. Almost everything counts for something. Intentions count for nothing (until you turn them into actions).

11. Common Questions, Quick Answers Whats the best exercise? No best exercise. What do you like to do, what will you do Whats the best exercise for someone with fibromyalgia? Same answer, see above But what if I cant exercise? Cant or choose not to? Fibromyalgia is not a reason not to exercise. Yes, there are some medical conditions for which it may be unsafe – FM is not one of them. Ive done it before, it doesnt help (or makes me worse). Try it again, in a different way.

12. Step 1: Whats important to you? Examples include (and these have come from individuals like yourselves) Picking up my grandchildren Going out to dinner with friends Working again Playing golf Playing music Take a moment to think of a few things that are important to you.

13. Step 2: Whats getting in your way? Examples include No time (we all get 24 hours to work with) No energy, too tired Hurts, hurts, hurts Dont have the money Dont have the space Dont like to Dont want to Take a moment to think of some things that get in your way and prevent exercise

14. Step 3: What do you like to do? Take a moment to think of things that involve movement that you like to do

15. Step 4: Whats -available? Equipment Environment – sidewalks, paths, steps, hallways (local public schools and malls) At home – video tapes, exercise ball or band, mat, soup cans, chairs, your own body weight Classes Aerobics of all sorts, Yoga, Tai Chi http://www.arthritis.org Partners, buddies Friends, colleagues, family, strangers

16. Step 5: Plan it, Write it, Do it Make a schedule Pick your days and times Write it down Cross it off when finished, give yourself a start, a pat on the back, etc.

17. An aside… Planning it…how often? Every other day is a good target Writing it…where? Keep a log Doing it…when? Remember – this is your treatment! You need to find the time for you!

18. Specifics….. Start each exercise period with a 5-min warm up Aerobic activity for whatever amount of time you can do comfortably and recover by your next session Increase your exercise time by 2 min every week of every other week Your final goal is 30 min of aerobic activity End each exercise period with a 5 min cool- down and some gentle stretching to lengthen your muscles Your total time investment when you reach your goal is 45 min three times weekly or every other day

19. Specific, cont…. Cross-training is just fine Wait on strength or resistance training until your aerobic fitness improves Stretching exercises should be done daily either after exercise or after a shower Never stretch a cold muscle

20. Step 6: Breaking down Barriers Review your success or failure Review barriers to success Remember pacing Problem solving

21. Just so you remember… Whats important? Whats getting in your way? What do you like to do? Whats available? Plan it, write it, do it! Break the barriers!

22. Tips for Better Sleep Follow a regular schedule…even on weekends! Avoid day-time naps Create a relaxing bedtime routine (warm glass of milk or reading) Watch caffeine consumption – avoid those types of beverages after 7pm Exercise early in the day

23. More helpful tips Be comfortable (right temperature, limited noise, and comfy bed) Relax!! Dont worry about trying to solve any problems Only use your bed for its intended purpose If you cant fall asleep, get up and try to do something to relax you and then return to bed

24. ABCs of a Healthy Lifestyle A im for Fitness B uild a Healthy Base C hoose Sensibly **Handouts available for good nutrition in your notebook