In the first study (1988), it was shown that cardiovascular fitness or flexibility exercise reduced FMS symptoms. This was a study of 42 patients with Fibromyalgia. At the end of the study, 83% improved in their aerobic stamina. Although their sleep and pain sites did not change during the study, they experienced less tenderness and better mental health characteristics. It was explained that exercise could impro9ve FMS symptoms in several ways. First, physical activity results in decreased pain sensitivity, referred to as "post-run hypoalgesia" because serum endorphin levels increase following exertion. Second, exercise leads to increased levels of adrenocorticotropic hormone cortisol and growth hormone, which can confer increased tolerance to pain and improved muscle fitness. Third, with improved fitness, the muscles are less susceptible to damage.
"A Controlled Study of the Effects of a Supervised Cardiovascular Fitness Training program on the Manifestations of Primary Fibromyalgia" by G.A. McCain, D. A. Bell, et. al., Arthritis and Rheumatism, Vol. 31, No. 9, Sept. 1988

Because pain and fatigue cause inactivity and deconditioning, which leads to more pain and fatigue, exercise was found to be a key aspect of FMS management in 1992. They suggested that low-impact, low-load, repetitive activity, such as brisk walking, biking, or swimming for 30 minutes 3-4 times a week will enhance general fitness, posture and flexibility, improve blood flow to the muscles, and contribute to a general sense of well-being. However, their model was a well person’s benefits applied to the FMS patient. They did not take into account the possible underlying physiological causes for pain and fatigue seen in FMS.
Physician and Sportsmedicine, Oct, 1992

The focus of the next four articles is on the role of muscles in Fibromyalgia and continued to play a huge role in the belief among physicians that exercise was good for those with FMS. (1990’s).

A 1995 Danish study evaluated a steady exercise program and an aerobic dance program in the treatment of FMS. Of 176 in the program, only 16 people completed the program. And, after 12 weeks, there was no improvement in pain, fatigue, general condition, sleep, muscle strength or aerobic capacity. They concluded that the high percentage of dropouts and the absence of improvement illustrated the difficulty in treating FMS with physical modalities.
Journal of Musculosketal Pain, The Haworth Medical Press, Vol. 5, No 1, 1997

In 1996, Norman Rosen. MD, a musculoskeletal specialist who is the director of Rehabilitation and Pain Management Associates in Maryland, and who suffers from FMS, spoke at the Oregon 96 Fibromyalgia National Convention about exercise. He said that muscles, tendons and joints tighten with inactivity. And tight muscles can impair balance, ease of movement, and posture. He explained that some FMS patients are reluctant to exercise because it’s painful and because they believe they might be doing more damage. "Hurt does not equal damage. "No pain, no gain—but don’t act insane!" is his motto. He urges his own patients to pace themselves and be a little gutsier about physical activity. He encourages us to take pain medications prior to exercise to prevent excessive discomfort.

In 1996, Canadian researchers found that patients reporting musculoskeletal pain exercised very little. The authors did not say definitively what caused the pain suffered by FMS patients. However, they speculated that the patients’ Musculosketal pain may have resulted in less physical activity, which in turn launched a cycle of continuing pain.
"Musculosketal Complaints and Fibromyalgia in Patients Attending a Respiratory Sleep Disorders Clinic", by F. Donald, ET. Al., The Journal of Rheumatology, Vol. 23, No 9, 1996

Then, in 1997, Robert Bennett, MD softened his view of exercise on FMS. He said, "Too vigorous exercise will cause a flare-up of FMS/CFS". When asked to explain his new view, he said it was known as the effect of the J-shaped curve. In general, he recommended that FMS/CFS patients who have not exercised for many years start out with no more than five minutes of exercise a week. This should gradually be increased to 20 minutes three times a week. This should be achieved over a six-month period. He went on to say that FMS/CFS patients need to "listen to their bodies". Although everyone who starts an exercise program feels sore initially, if the soreness persists for more than three days, they have done too much. He encourages us to not give up on stretching and low-impact aerobic exercise due to this experience. Exercise, he said, may not improve our condition, but it is one of the keys to coping with FMS/CFS. And, finally he indicated that there are a variety of muscle conditions with a defective energy machinery (mitochondria) which may present in FMS/CFS with reduced exercise capacity, muscle cramps during exercise, and muscle weakness.
Sapient Health Network, March, 1998

In his 1997 book "From Fatigued to Fantastic", Jacob Teitelbaum, MD reports on exercise. As a sufferer of FMS, he has evaluated the effects of exercise from his own perspective. He concludes that exercise is very important for our sense of well being. But, that post-exertion exhaustion is a real problem with those with FMS/CFS. He suggests that as our health starts to improve, slowly add exercise to our regime. Begin with something gentle, such as walking or swimming. If we feel exhausted the next day, we probably pushed too hard and should take it easier the next time. He feels that as our symptoms improve, our post-exhaustion will change to a "good tired" for a couple of hours and then to a good feeling the next day. He recommends walking as the primary exercise for those with FMS/CFS.
From Fatigue to Fantastic, Avery Publishing Group, New York, 1997,p 72-73

Paul Cheney, MD of the Cheney Clinic in North Carolina, a clinic specializing in CFS/FMS since 1994, comments on recent knowledge concerning exercise. He cautions against aerobic exercise—-any kind of sustained activity, such as running or walking or swimming, designed to raise the heart rate and increase oxygen flow throughout the body. He explains that exercise beyond a certain point can further damage the mitochondria (energy producing part of the cells). This system appears to be malfunctioning in CFS/FMS patients and is vulnerable to excessive aerobic exercise. (In a previous Shasta CFIDS newsletter, a report on the role of L-Carnitine on improving the mitochondria of the cells shows promise. The recommendation is for 3-4 grams of L-Carnitine a day. Enterprise Pharmacy can compound the prescription for you.) Dr. Cheney explained, however, that our anaerobic system appears to be in much better shape. This allows people to maintain muscle tone and strength with such exercises as weightlifting, isometrics and stretching. He recommends a routine of 10 seconds of activity followed by 60 seconds of rest. One particular activity he has found to be useful is rebounding or bouncing, using a bungee cord contraption called a bounce-back chair. NASA researched the rebounding concept in 1980 to help astronauts counter the effects of the weightlessness of space travel. Its benefits seem to related to the physiology in Chinese medicine of balancing body systems, as it seems to help restore the autonomic nervous system balance that is out of whack in CFIDS patients.
The CFIDS Chronicle, July/August, 1998