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Case study: client with fibromyalgia

This is an excerpt from NSCA's Essentials of Training Special Populations by NSCA -National Strength & Conditioning Association & Patrick L. Jacobs.

Case Study

  • Sex: Female
  • Race: Caucasian
  • Age: 43
  • Height: 5 feet, 3 inches (1.60 m)
  • Weight: 145 pounds (66 kg)
  • Body fat: 32%
  • Body mass index: 25.7
  • Resting heart rate: 72 beats/min
  • Blood pressure: 142/94 mmHg
  • Temperature: Normal


History

Mrs. P is a receptionist in a dental office. Her job entails sitting for long periods of time, entering information into a computer, and retrieving dental records. For several years she has noticed diffuse muscle discomfort throughout her upper body and thighs. She has made several modifications to her workstation to help alleviate her issues, but this has been unsuccessful. Her physical discomfort has made working quite difficult as well as straining her relationships at home. Following a serious car accident, she noticed a marked increase in her symptoms and great difficulty sleeping. After minimal success with physical therapy, she was diagnosed with FM by her primary physician. The physician prescribed NSAIDs, antidepressants, and a sleep aid. Having attempted alternative forms of treatment, Mrs. P sought the help of an exercise professional who was knowledgeable about FM.


Goals

Mrs. P hopes to work with her exercise professional to reach the following goals:

  1. Alleviate consistent muscular pain
  2. Improve quality of work and home life
  3. Establish exercise programming as a regular part of treatment
  4. Improve overall fitness


Initial Training

Having received clearance from her primary physician, Mrs. P met with a certified exercise specialist at a facility near her home. The exercise professional took a full medical history. Traditional submaximal aerobic and muscular exercise testing was attempted, but results were not accurate due to Mrs. P's low physical capacity. As an alternative, the exercise specialist performed the University of Houston Non-Exercise Test to assess her aerobic capacity and a dynamometer battery consisting of handgrip strength and back and leg strength. Body composition was measured using bioelectric impedance. The exercise professional recommended a slow but progressive approach to achieving a regular exercise program for Mrs. P and recommended a progressive resistance training program, flexibility training, and regimen of cardiopulmonary exercise. Ultimately, the exercise program will need to become a regular part of Mrs. P's treatment plan. It was also recommended that she seek the counsel of a registered dietician to help promote better general health.


Exercise Progression

Resistance training began with a combination of 8 to 10 movements consisting of both bodyweight and resistance band exercises, two days per week. One set of 10 to 15 repetitions was performed for each exercise. While 1- to 2-minute rest periods were appropriate, early training rest periods were variable. Each session was completed with light full-body static stretching. Each stretch was held for 10 to 15 seconds. Aerobic sessions were scheduled on days in which resistance training was not done. Because of Mrs. P's preference, aerobic training was conducted twice per week in a swimming pool. Her group instructor aided her in completion of one or two 5- or 10-minute intervals of activity. All early training was kept below the point of volitional fatigue.


Resistance training frequency was increased to three or four times per week. While repetitions remained in the 10 to 15 range, the number of sets was increased to two or three. To accommodate this change, different muscle groups were trained on different days. Aerobic training progressed from intervals to single sessions of 20 to 30 minutes, three or four days per week. The client also began to explore other aerobic modes. Her training schedule remained flexible and was adjusted as needed depending on her symptoms.


Outcomes

Following some minor setbacks as she learned her exercise tolerances, Mrs. P was able to establish a routine that fit within the structure of her life. Her physical condition improved, as did her quality of life. The combination of her therapies and dietary modifications has been effective. Although she still deals with pain, it is dramatically less than before. The strain on her home and work relationships is better.