Text Size
Exercise is one of the most-commonly prescribed treatments for FM and can be helpful for CFS as well. An exercise program done regularly can help reduce stiffness, counteract deconditioning and improve outlook. But if not done in a way that respects limits, it can be the cause of relapses so it's best to proceed carefully and check with your doctor.

Here are four guidelines for exercise plus thoughts on the related topic of posture and movement.
1) Individualize Your Program

Your exercise program should be tailored to your unique situation. The type, duration and intensity of exercise will depend on the severity of your illness. Also, your exercise program should take into account your better and worse times of day.

Exercise programs for CFS often focus on flexibility and strength training. Pacing should be aplied, so that a period of activity is alternated with rest. For people with severe CFS, the time of exertion might be only a minute, followed by up to several minutes of rest.

An exercise program for fibro can begin with stretching and normally includes both an endurance component such as walking or pool exercise, and strength training two or three times a week.
2) Set Realistic Goals

Exercise has a different purpose for CFS and FM patients than for healthy people. Healthy people can set high goals and push themselves. That approach is likely to make symptoms worse for people with CFS and fibromyalgia. 

An appropriate exercise goal for CFS would be to improve fitness enough to make daily activities easier. For fibromyalgia, it is the same plus using exercise to reduce stiffness and pain. For an example of exercising safely with CFS, see Using Targets to Improve Health and Gain Control in the Success Stories section of this site.
3) Start Low and Go Slow

Begin by finding a safe level of exercise, one that is matched to your current level of functioning and which does not intensify your symptoms either afterwards or the next day (effects can be delayed).
Dr. Lapp starts his patients with range of motion exercises (stretching). If that is tolerated, he moves on in turn to light resistance exercise (eight ounce weights or stretchy rubber bands such as Therabands); light aerobic activities such as walking in place, walking short distances at a comfortable pace, riding a stationary bike or water walking in a pool; and finally full aerobic activities such as brisk walking, biking or swimming.
Periods of activity should be alternated with rest, so that several minutes of exertion is followed by an equal or greater amount of time resting. For example, walk for five minutes, then sit for five minutes. The length of activity and rest periods will vary from person to person, but might be as little as one to three minutes. 

The goal of the exercise program is to have a sustainable level of effort that you can do several times a week, typically every other day, without worsening your symptoms. If your program triggers a flare, reduce it by 50% or return to a level that you can tolerate.
4) Use Logging and/or Devices to Monitor Your Activity

Remembering that your goal is to have a level of activity that does not intensify your symptoms, you can evaluate your activity by keeping records and by using a pedometer (step counter) and/or a heart rate monitor.
An exercise log can enable you to associate activity and symptoms. Note the time and duration of exercise, its intensity and your symptom level before, during, after and the next day. You can note symptoms using a ten point scale or letters like L, M and H (low, medium and high). For more on record keeping, see the logging page.
You can use a pedometer to measure your overall activity level. Dr. Lapp believes that between 1,000 and 5,000 steps a day is a good range for many people with CFS and fibromyalgia. If someone has fewer than 500 steps a day, Dr. Lapp usually suggests they gradually increase the number of steps they take.
If someone is over 5,000 steps a day, Dr. Lapp finds they are usually too active and he advises them to cut back. Dr. Lapp's guidelines imply that 10,000 steps a day, an exercise target often suggested for healthy people, will be inappropriate for most people with CFS and FM.  For more on using step counters, see the article Pedometers: A Tool for Pacing.
Another device, a heart rate monitor, can help you avoid the intensification of symptoms that results from a too-high heart rate. Because activity beyond a threshold triggers flares, keeping the heart rate below that threshold prevents flares. 

Some people can exceed their threshold with everyday activities such as climbing a flight of stairs or lifting a child. For how to determine your threshold and strategies for staying within it, see the article Pacing By Numbers: Using Your Heart Rate to Stay Inside the Energy Envelope.
Posture & Movement
People with fibromyalgia can help reduce their pain by experimenting with how they hold their body and how they move. Many find that staying in one position for an extended period of time, sometimes as little as 20 to 30 minutes, increases stiffness and intensifies pain. Moving periodically can help, as can limiting the length of time spent doing repetitive motions like chopping vegetables. Some people are helped by Tai Chi.
Being attentive to posture can help as well. Since people with FM tend to slouch, which puts tension on muscles in the neck and shoulders, Dr Lapp teaches his patients to sit up straight, holding the shoulders back and tucking in the chin.