Welcome back to mind your fibro podcast episode #26
Today we continue talking about the trilogy of health- nutrition, sleep, and physical activity. Nutrition, sleep, and exercise are the health foundation everyone needs, not just those with chronic pain, autoimmune conditions, or fibromyalgia; if you have not listened to prior episodes where I discussed nutrition and sleep, make sure you go back and find those.
Today I am starting the discussion on exercise and physical activity for patients with fibromyalgia and chronic pain.
Similarly, to the episodes on nutrition and diets, I am going to explore the why exercise is essential for you and how you can incorporate it successfully into your life.
So why do doctors recommend adding exercise as a treatment plan for fibromyalgia?
According to Nature is a weekly international journal publishing the finest peer-reviewed research in all fields of science and technology, it’s latest article on fibromyalgia and exercise from June 20th, 2022 – I will put a link to it in the show notes.
This article is a meta-analysis, or a review of all published studies on fibro and exercise, excluded the poor quality ones and analyzed 18 solid studies for impact of exercise on fibro symptoms as well as type of exercise that showed benefit.
So the objective of this study was to summarize, through a systematic review, the available evidence on the effects of aerobic, resistance and stretching exercise on pain, depression, and quality of life in patients with fibromyalgia.
So the results of this analysis showed that the exercise, regardless of type, reduces pain, depression and improves overall quality of life. So if you’ve been getting conflicting information about what exercise is best – pick what you like, be consistent and it will help with fibro symptoms.
I agree with the study. My clinic experience shows similar results. The patients who are successful with managing their fibro symptoms universally credit the exercise, sleep and nutrition as essential treatment modalities for the control of their symptoms. No, these patients may use different exercise types, one maybe into yoga, another swimming or walking, etc. but they all move.
So if you are working on managing your symptoms better, tune in for the next several episodes and learn how you can incorporate exercise into your life.
Now, I want to admit that I am not a sporty person. I grew up in the Soviet Union, and my family never emphasized the importance of physical activity, played sports, or even watched sports. I never played any team sports as a child or adult. But growing up in a large city, in a country where owning a car was a luxury, we were all very physically active by necessity - walking to school and to the after-school activities, and grocery store, we lived in an apartment building with no elevator, so hulling up groceries without an elevator 4 to 7 floors up was a norm. Kids played outside, biked, ran around after school and all summer, and there were no electronics, most of my childhood I watched black and white TV. So we were active without trying. Moving to the US when I was 16 years old removed that built-in exercise. We adapted to the American lifestyle, living in a suburban neighborhood, driving to work, school, and grocery store. That, coupled with abundant food options, especially sweets, led my entire family to become overweight. So I have battled with weight since my twenties. Like most women, I tried many diets and successfully lost weight just to gain it back. As I learned more about nutrition, metabolism, mindset, and coaching, I moved away from the diet mentality to more mindful and intuitive eating, but weight is still an issue for me. But learning and practicing healthy eating is easier for me than exercise - I love cooking and feeding my family. Exercise, not so much; I still do not sport. I still lack the motivation to move and use walking primarily as exercise, especially now as we got our dog. Of course, in the house with three teenagers, mom is the one walking the dog, which honestly I do not mind at all, as it gets me moving, and I get to listen to audiobooks and podcasts; it is my favorite part of the day, kids say that the dog and the mom bark less if we get our walk. I do feel better physically and mentally when I exercise, especially when I do resistance and weights. So, this is a warning that I am not an expert on physical activity, but I exercise enough to know the positive benefits it provides me, physically and mentally. I also sympathize with you if you don't feel like moving because I want to be honest; I don't either, but I do it anyway.
So, I envision several episodes about exercise. Since I am no expert, I am enlisting experts to discuss various physical activities, including physical therapy, yoga, pelvic PT, etc. Like diet, physical activity is not a one-size-fits-all solution. What works for some people will not work for others.
In my clinic, patients often talk about why they cannot exercise, often due to pain and fatigue. Many also assume that exercise is only needed for weight loss or to maintain the weight -naturally because we are bombarded with messages from doctors and media about diet and exercise. Many patients tell me how they want but can't lose weight because they cannot exercise, thus they are still overweight. It is a frustrating dilemma, especially for some patients who need to lose weight, for example, to get their knee or hip replacement surgery, and they feel stuck - they can't move because they have pain in their knee or hip, and they say they cannot lose weight because they don't exercise.
I may oversimplify a little, but this will apply to the majority. For your success, I want you to separate these two issues - weight and exercise. I like to keep things simple and avoid allowing our brains to find excuses or self-sabotage.
Most people did not gain weight because of lack of exercise but because of overeating. So, overeating is weight gain; if you eat when you are not hungry and don't stop when you are already full, you will likely gain weight. If you answer every food or drink craving, regardless of hunger, if you are stress-eat or comfort-eat, you and most people will gain weight even if you exercise. If you used to exercise, and your metabolism and hunger were adjusted to that level of activity, and if you stopped exercising but continued to eat as if you are still active, you and most people will likely gain weight - look at the retired or injured professional or really any athlete who quit the sport but continued eating as if they are spending hours in the gym, but it's not because of lack of exercise - it's because they are over-eating - eating more than their bodies need for energy. If you eat like you are training to run a marathon, but you are not running a marathon, your body will store that food energy until you do run a marathon, but most likely, most of us will not train or run a marathon. Look how we gained weight on vacations when we ate way more than we typically eat but also walked a lot or swam in the ocean. How easy is it to gain weight in Disney world, sweating as you walk 20-30 thousand steps in the heat as you eat delicious foods at Epcot and that Mickie mouse ice cream bar as you wait in line for your ride?
So, eating when you are hungry and stopping when you are full, not answer food urges, and avoid processed foods is the way to lose or maintain your weight. Now, if you are trying to lose weight and already eating when you are hungry, adding exercise will help you reach your weight goal faster, and it will make you feel better.
Physical activity or exercise - think of it as a way to maintain your muscle and bone health and improve your endurance, fatigue, and general and mental health. We, humans, were made for physical activity- to hunt and gather, not sit on the couch, munching on snacks, and watching TV. There are about 600 muscles in the human body. 600! 600 parts that need to move!
So if we change from a human body to another analogy like a car, it may be easier to visualize.. if you have a luxury car, you love it, you saved a lot of money to buy it - and you park it in a garage and don't drive it... After some time, the car's fluids will get all guppy, the resin and plastic will start to be more crumbly, like the tires will dry up and crumple, the car will squeak more as you drive it, and the steering wheel will be all stiff and hard to turn, the battery will die, and the car overall will not live up to it's potential. So like cars, our bodies were meant to move, or our muscles get atrophied, our fluids get guppy, our heart - our engine does not accelerate as well, and our nervous system gets dysregulated, and our mental health crumples. We like any moving thing, were designed to move.
But, if you have fibromyalgia, chronic pain, or a painful autoimmune condition, you may find it hard to want to move - if someone has pain and fatigue, movement is probably the last thing on your mind. Motivating yourself to move when your body wants to stay in bed is hard. You also may have tried to exercise before, move a little, and it may have increased your pain, or your energy crashed after, and now you don't know how to start moving more without an increase in pain or crashing, or you have a fear of anticipation of pain or fatigue. Or you may enjoy physical activity, but your brain talks you out of it, finding every excuse not to do it. Or you constantly push and crash.
Many studies done over decades on fibromyalgia found that physical activity helps with all fibro symptoms, including pain and fatigue, a well as mental benefits to reduce anxiety and depression. The goal for every fibro patient is to move at least 30 minutes per day, every day. So future episodes will discuss how to start moving the right way, what works best for patients with fibro and chronic pain. But today we are talking about motivation. I am no expert on physical activity, but I know how our brains work and coach anyone on that.
How do you find your motivation to add a daily physical activity?
So, I know my brain, and I find my motivation to do things when I understand why and how things work - when I know the why and how it makes it easier to want to do something and actually do it.
Then, I consciously engage at a higher level and design my life, doing things my primitive brain does not want me to do. I do it anyway. And I understandably produce better results when I am disciplined enough to stay on that course continuously, which is a work in progress for me. I accept my brain is a human brain, and needs guidance, so I coach myself to do things I need to do.
So, let's discuss motivation.
Our minds and bodies are amazingly complicated. Our mind determines what we think, say, and do, from simply taking a breath to craving foods to exercising or staying in bed, doing complex tasks at work, and planning a family vacation. Yet who we are and what we do can be boiled down into a rather primitive premise – we are primarily programmed to survive for as long as possible efficiently and to pass on what we learn and do to the next generation. So we inherited the information from our ancestors that is programmed in our genes and DNA that healthy nutrition and exercise are healthy for us; most of us know and agree with it, but why is it so hard to follow? The answer is simple. The benefits of good health are long-term and require hard work to achieve. Yet, our brain's most influential and authoritative section is structured around our survival and is very impulsive, always looking for the easy way out.
So why is it that we prefer junk food over salad? Why do we resist doing that workout? Or why do we spend countless hours watching TV or on social media? Because the most powerful motivational and emotional drivers reside in the more primitive part of the brain and guide our existence through the lens of survival and procreation and have three goals: to seek pleasure, avoid pain, and conserve energy.
To seek out pleasure and have desires, happiness, and comfort leads us to reproduction, but also tasty, comforting foods, social relationships and romance, shopping, acceptance and recognition by others, and other life pleasures.
To avoid pain includes avoiding both physical and mental pain and discomfort, not just immediate but also anticipated pain and discomfort. Typically, this is driven by having fears, anxiety, and doubt - like fear this will cause pain, so avoid doing it. Fear and anxiety are evolutionary protective, and so is avoidance of doing hard and painful things.
Next is to conserve energy and seek efficiency. This is when the human brain directs us to do less mentally and physically. Energy comes from food and is used up by activity. Because the food was a limited resource million years ago, and people did not live with hundreds of pounds of stored excess weight or fat on their bodies but ate the food they had and conserved the energy from it until the next meal or hunt. The efficiency and conservation of energy is a primitive survival mechanism, it includes conserving physical and mental energy – doing less, so energy lasts longer.
So if your brain's motivations triad is to seek pleasure, avoid pain, and conserve energy. Exercise is not part of it. If you don't move enough and are not physically conditioned, exercise will produce some pain or discomfort. Exercise that is not part of your daily activities, is an additional energy expenditure, that requires planning, as in use of your mental energy, resources. And unless you love exercising does not provide much pleasure, and likely not as fun as watching TV or eating a tasty meal. No wonder most of us do not want to exercise - it goes against our pre-programmed primitive brain function.
So, stop judging yourself and beating yourself up for not wanting to add physical activity to your busy day, especially if you have pain or are tired because your primitive brain is doing its job focusing on your survival.
But ask yourself another question. Do you want to live in a survivor mode, answering to the primitive brain as if you still live in a cavemen's time?
Because your higher functioning brain, the cortex, can step in, step up and override the lower brain if you set your mind to it...
So, just like the podcast title, mind your fibro; you can mind your fibro, pain, nutrition, physical activity, and life goals, and you do not have to survive your life but enjoy actually living it. By bringing awareness to your mind, your nervous system, your primitive and advanced brains, your thoughts, beliefs, and understanding your motivation, you can create the life you want to live, little by little. Even with pain, and even with brain fog and fatigue. But it will need your intentional and conscious input, the recognition that your primitive brain wants you to do nothing, so you avoid pain, save your energy and maybe gain a little bit of pleasure... Regulating your nervous system, eating well, and moving more are all intentional acts, and only you, not your doctors, or family members, or government, can do for you. Learn to recognize that your brain directs you to do less and find your way to do things anyway. Let’s go!
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