Exercise, relaxation and stress management

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Gentle physical exercise can reduce pain and tiredness in people with fibromyalgia. Relaxation and stress management techniques aim to help people become more aware of their bodies, recognize their own limitations and cope better with stress.

Staying physically active is particularly important in fibromyalgia. That can be difficult if you’re always exhausted, though. Many people who have fibromyalgia avoid exercise because they’re afraid that it might be too much for them and make their symptoms worse. But studies have shown that gentle physical exercise can improve their fitness and wellbeing, and relieve the pain somewhat.

If someone has already had fibromyalgia for a while and has been avoiding exercise because of the pain, it’s best for them to start doing very gentle exercises at first and then gradually increase the intensity. For instance, the goal may be to do low-intensity endurance exercise (e.g. Nordic walking, cycling, dancing or deep water running) for 30 to 60 minutes two or three times a week. Gentle strength training exercises using weights, elastic exercise bands or exercise equipment can help too, as well as (water) aerobics, whole body vibration or stretching exercises. Meditative forms of movement such as tai chi, qigong and gentle yoga styles are also an option. Different types of movement appear to be suitable for reducing pain and tiredness, and becoming more mobile.

In Germany, statutory health insurers cover the costs of group functional training classes (“Funktionstraining”) for people with fibromyalgia, for up to 24 months. Functional training involves simple exercises or water exercises that are done under the instruction of a physiotherapist. Doctors can prescribe functional training using a special form, without it having a negative effect on their budget.

What is mindfulness training?

Mindfulness training (mindfulness-based stress reduction, or MBSR) aims to help people pay more attention to their thoughts, feelings, and surroundings – without judging or wanting to change them. This is meant to improve your self-awareness and allow you to experience events, activities or moments in a more intensive way and enjoy them more.

Mindfulness training also aims to help you recognize negative thoughts and feelings that are easy to get caught up in, and then distance yourself from them.

There is very little good-quality research in this area, though, so we can’t yet know for sure whether these goals can actually be achieved through mindfulness training.

Various approaches are used. For instance, people try to become more aware of everyday things such as the taste of their food, or the wind in their face when they go on walks. Or they may try to avoid reacting immediately to what others say or do, and instead slow down and take their time. Meditation and yoga can be used in mindfulness training too. All of these approaches aim to stop our “autopilot” that makes us react automatically to things without us being aware of it.

Mindfulness courses are offered by some adult education centers (In German: Volkshochschulen) and statutory health insurers in Germany – and sometimes subsidized too. It is also possible to learn mindfulness techniques with the help of an online course, an app, CD or audio file. Mindfulness is often used in psychological treatments too.

Can biofeedback help?

Biofeedback involves trying to consciously influence subconscious body functions and learn to control them better. This is also meant to help people manage pain better.

Biofeedback can be carried out by a doctor, a therapist or at home with a portable device – after being shown how to use it properly. It involves placing electrodes on your body to measure things like muscle tension or brain activity. You can monitor these different measurements on a screen and try to influence them by consciously relaxing your muscles or thinking particular thoughts.

What relaxation techniques can be used?

Relaxation techniques such as progressive muscle relaxation or autogenic training can help you to reduce tension in your muscles and let your body relax.

Progressive muscle relaxation involves concentrating on certain groups of muscles, consciously tensing them and then relaxing them again. This is repeated with other muscle groups until the entire body is relaxed. The aim is to become more aware of your body and learn to consciously achieve physical and mental relaxation.

In autogenic training you picture different parts of your body, focus on how they feel, then consciously relax them. People who are very good at it can even influence involuntary bodily functions like their heartbeat, helping them to achieve deep physical relaxation.

Relaxation techniques can be learned in classes or with the help of video or audio instructions. They are often used in multimodal pain management and psychological treatments too.

Other ways to relax and relieve symptoms include guided self-hypnosis and visualization techniques (also known as “guided imagery”).

There are only a few small studies on relaxation techniques, mindfulness training and in people who have fibromyalgia, so it isn't possible to say whether they work here. But that doesn’t mean that they don’t work. Further research is needed to properly assess how effective they are.

How can patient education help?

In patient education programs, people are given information about their disease, the treatment options and strategies to cope better in everyday life. They also have the opportunity to talk to others in similar situations. Patient education is mainly organized by support groups and is often an integral part of multimodal pain management approaches.

Bidonde J, Busch AJ, Schachter CL et al. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst Rev 2019; (5): CD013340.

Bidonde J, Busch AJ, van der Spuy I et al. Whole body vibration exercise training for fibromyalgia. Cochrane Database Syst Rev 2017; (9): CD011755.

Busch AJ, Webber SC, Richards RS et al. Resistance exercise training for fibromyalgia. Cochrane Database Syst Rev 2013; (12): CD010884.

Haugmark T, Hagen KB, Smedslund G et al. Mindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses. PLoS One 2019; 14(9): e0221897.

Theadom A, Cropley M, Smith HE et al. Mind and body therapy for fibromyalgia. Cochrane Database Syst Rev 2015; (4): CD001980.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

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Updated on May 24, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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