Fibromyalgia is a chronic condition that causes widespread muscle pain and tenderness. It is often accompanied by fatigue, altered sleep, cognitive disturbance and emotional distress. It usually develops in middle adulthood and affects more women than men. In Australia, fibromyalgia affects 2% to 5% of the population.

An exercise physiologist, Sarah Comensoli, says many people with fibromyalgia worry exercise will make their pain worse. That concern is reasonable – it isn’t uncommon that people with fibromyalgia experience more post-workout pain and tiredness when they first begin exercising.

“Exercise induces fatigue,” says Prof Geoffrey Littlejohn, a rheumatologist at the department of medicine at Monash University. “It’s a bit of a catch-22, that one of the most effective treatments can aggravate the symptoms of the condition, at least initially.”

The combination of pain, fatigue, and inactivity often leads to weak and deconditioned muscles, making ordinary daily activities challenging. But research has shown that exercise can alleviate symptoms. “It’s one of the most proven treatments for fibromyalgia,” Littlejohn says.

Comensolisi says: “Exercise helps people maintain and improve their functional capacity. If you get into a good routine, that might also improve sleep duration and quality.”

Exercise can also boost mood and resilience. “A lot of people with fibromyalgia experience a loss of control,” Littlejohn says. “Exercise puts that back in their own hands.”

Before starting any exercise routine, get advice from your doctor or physiotherapist. They can suggest safe exercises tailored to your condition and ability.

The class: hydrotherapy

According to Littlejohn, people with fibromyalgia can benefit from hydrotherapy because the water supports their body. “You can do more things than you can on land without causing too much stirring up of the pain.”

Exercising in a warm pool can offer multiple benefits. The water’s buoyancy relieves stress on the joints, and the warmth helps tight muscles relax. A gentle water workout in the hydrotherapy pool, usually at a temperature of 34C, can reduce stiffness and alleviate muscle spasms, resulting in greater flexibility and range of motion.

Comensoli warns that people should still assess the classes they want to attend. “A lot of group classes run for 45 to 60 minutes, and that can be too much for some people.”

The move: pilates bridge

“One thing we love people to remain able to do for a long time is getting up off a chair without their hands,” says Comensoli. “That’s how you get off your couch, get off the toilet, get out of your car. If you can do that, then life is going to be a little bit easier.”

To help the body maintain such function, Comensoli suggests strengthening the glutes and leg muscles with a pilates-style bridge exercise.

Comensoli says a few repetitions of the bridge exercise might be a good starting point. “Simply starting with some mobility exercises to get the legs moving, then go up to do strength work.”

“We’re trying to encourage gentle movement that the body can cope with, but then we progress over time.”

The activity: walking

Regular aerobic exercise that gets the heart beating a little faster can improve fitness and help with pain and fatigue. Aerobic activities include walking, swimming, cycling and dancing.

None of these is necessarily better than the others, but it’s best to do something you enjoy, says Comensoli.

She says walking is a great activity to start breaking up sedentary time. It is accessible to most and can be easily paced according to abilities.

“Walking is great if they like being outside. It might also be a way to socialise – walking with a friend might be great.”

The hard pass: over-exertion

People with fibromyalgia can experience pain very quickly because their pain system is over-sensitive and reacts to minimal activity. Some people can develop high pain tolerance and push through pain. But when this happens, their pain system becomes even more sensitive, so they might experience pain sooner next time. Pushing through pain might send a “threat” or “danger” signal to the brain. The brain interprets the signal as a “need for protection”, and its way of protecting the body is to make pain.

“Don’t push towards maximal fitness too quickly.”

“My philosophy is not to put any activity in the ‘never, ever’ category,” says Comensoli. She says no specific exercise must be avoided, but the level of activity must be tailored to the individual’s condition and abilities.