Meet Jacqui. Shes a 64-year-old client of mine who started working with me to get help with her fibromyalgia. Which symptoms was she experiencing?

  • The obvious muscle pain
  • Weakness
  • Lethargy, and low energy levels
  • Insomnia

and others.

               Fast forward 11 weeks that weve been working together, and her success has been nothing short of monumental. Nowadays, she:

  • Has so much energy some days she doesnt know what to do with herself
  • Gets so much more done in her day, from the simple household things, like laundry, to shopping, playing with her cats, and more
  • Likes how her legs and waist look.

Not really something she could have imagined just 11 short weeks ago.

If youd like to see Jacqui tell her own story, check out the video below.

In this article, well cover:

  • How the fibromyalgia was affecting Jacqui
  • What shes tried in the past to help her with the fibromyalgia
  • The physical exercises we used with her, and special adjustments we made for fibromyalgia
  • The mental/cognitive exercises we used with her
  • Strategies we used to improve her sleep
  • The bottom-line results shes achieved
  • How her life is different now

If you have fibromyalgia yourself, we have a special program called Fibro Fit, which is specific for people with fibromyalgia. If youd like to see whether you qualify for this program, just email me with the subject line Fibro Fit.

How the Fibromyalgia Was Affecting Jacqui

               Jacqui originally noticed that she wasnt herself, when she was working a very stressful job in the mid-90s.

               She ended up going to her doctor, who diagnosed her with both fibromyalgia, and to go along with that, insomnia.

               She was actually somewhat lucky to get diagnosed with fibromyalgia in the mid-90s, because at that time, a lot of doctors didnt even believe that diagnosis, and dismissed it either as a person having depression, or just wanting attention. Now, we know better. And with a bad diagnosis, people with fibromyalgia either got a bad treatment, or no treatment whatsoever.

               Pretty soon, the fibromyalgia started taking over Jacquis life:

  • Some days, she had no energy, and was feeling lethargic almost all the time
  • She stayed at home, and didnt feel like going out and being social
  • Simple household chores, like laundry and cooking became difficult
  • Forget about exercise she didnt have the energy to do simple household chores, never mind expending energy at the gym
  • Sometimes after a day when she did a bit extra, she paid the price the next 1-3 days, by pretty much just staying in bed, because it really knocked her out.

As if that wasnt bad enough, fibromyalgia frequently comes along with insomnia, and sleep disturbances, which is a double whammy (it sometimes comes with psychiatric issues like anxiety and depression, but fortunately, that wasnt the case for Jacqui). Youre tired and exhausted from the fibromyalgia, but you cant sleep well. And you cant sleep well, so you have even less energy.

What a vicious cycle. Thats been going on since the mid-90s.

What Jacqui Tried in the Past to Help Her with the Fibromyalgia

               You can imagine that nobody wants to live this kind of life, so shes tried a bunch of different things to help her with fibromyalgia, pain, and sleep:

  • In her words, shes gone to every clinic you can imagine. Eventually, around 2007, she found a pain clinic, that shes been going to since, for monthly pain injections. Which helped, but only very slightly.
  • Medications galore from antidepressants, to insomnia medications (some real heavy artillery medications), and others.
  • Supplements: the typical ones that are used for sleep magnesium, melatonin, Valerian root, and others.
  • Dietary changes

and nothing really had a significant effect. The effects were somewhere between maybe I feel something, but its not very pronounced to this doesnt work at all.

               After over 25 years of this, she decided to try something shes never really tried before in any serious way: exercise and personal training.

               Of course, as a fibromyalgia sufferer, she had a lot of doubts and hesitations about exercise:

  • What if I cant do any exercise?
  • What if Im so sore, itll put me in bed for days?
  • I just dont know what to do once Im in the gym. The only thing Ive ever done is cardio.

She figured shed be better off if she just started the right way to begin with. So she hired a personal trainer. Me

After reading my newsletters for a few months, she decided to give it a shot. She liked that personal training was well personal. We dont have a set program that every single client goes through, regardless of who they are. Each program is personalized to the client. The program is meant to fit the client. Not the other way around. The client isnt meant to fit the program. We are client-centric, not program-centric.

Jacquis Exercise Program

               After our initial assessment, where we gather information about Jacquis goals, injuries, medical conditions, medications, and more, I put together her exercise program.

               The goals of exercise for folks with fibromyalgia are:

  • Improve strength, so that the activities of daily living become easier
  • Improve endurance, so that they can get more done in their day, without feeling tired the next day
  • Decrease muscle pain and tender points
  • Change the way they perceive physical exertion

so we got to work.

               An exercise program for someone with fibromyalgia is aimed at making their life outside the gym easier as opposed to getting gym strong you look strong in the gym, but when you step into the real world, the strength you built in the gym doesnt carry over outside of that.

               So we used exercises like:

  • One-legged deadlifts, which make it easier to pick up objects off the ground (groceries, pets, furniture, etc.)
  • Squats, which make it easier to get off chairs, couches, and well the toilet
  • Overhead presses, which make it easier to put objects in cupboards that are high up
  • Seated rows, which make it easier to pull things (like opening doors, etc.)
  • Incline pushups, which make it easier to push things (like when shoveling snow, mowing the lawn, etc.)
  • Lat pulldowns, which strengthen the back muscles, as well as the arms
  • Planks, side planks, and back extensions, which stabilize the spine and core, and make the back much less prone to going out.

But if you just read about the exercises, youd miss the secret sauce of the exercise program the progression model, and the workout-by-workout adjustments that we made based on her progress from the previous workout, energy/fatigue levels, injuries, and more. After all, no exercise program should be a static program, where youre doing the same exercises for the same weights, sets and reps every single time. An exercise program should be dynamic, intelligently, purposefully, and systematically changing the exercise variables workout-by-workout to move the client forward as opposed to haphazardly changing the program whenever you feel like it, without rhyme or reason like a lot of personal trainers do.

At the end of every strength training session, we also do 11 minutes of cardio. How did we do it? Wed warm up for 2 minutes (a short warmup was needed, because she was already warm from strength training), followed by a 1-minute interval, at a speed that would elicit a pulse of 135-145 beats per minute (bpm) by the end of the minute.

Notice that I said the pulse, and not the actual speed in miles per hour. Why did I do that? Because speed is meaningless without knowing the physiological effect of that speed on Jacquis body. Furthermore, the speed that used to elicit that pulse after 6 weeks of cardio is not the same speed that used to elicit that pulse at the beginning of her program. As she got in better shape, we raised the speed, because her heart and lungs could handle it. And we used biometrics (her pulse) to figure out when is the appropriate time to raise the speed. We didnt do it randomly.

After the 1-minute interval, wed walk at a slower speed for 2 minutes, and then do 2 more intervals, followed by a 2-minute cooldown.

What was the purpose of doing cardio for Jacqui? To boost her capacity to do her activities of daily living (ADLs). If, hypothetically speaking, her maximum capacity is 10 points, and her ADLs took 8 points from her, they came pretty close to her maximal capacity. But if we could increase her maximum capacity from 10 to 15, and her ADLs still only take 8 points, thats now only about half of her capacity. Which explains why shes able to get so much more done in her day. From just 11 minutes of cardio, twice a week. But it was purposeful, targeted cardio. Not random cardio that pays no attention to the pulse and changes in pulse.

I talk more about strength training over 60 in my article on that topic.

Mental/Cognitive Exercises We Did with Jacqui

               In addition to Jacquis physical training, I also have her doing mental/cognitive training.

               There are many theories about the causes of fibromyalgia, like:

  • The serotonin hypothesis: maybe theres not enough serotonin in the brain
  • The emotional trauma hypothesis: maybe emotional pain translates to physical pain
  • The muscular glucose hypothesis: maybe theres not enough sugar reaching the muscles
  • The adrenal hypothesis: maybe theres some sort of dysregulation with whats called the HPA axis (for the geeks, thats the hypothalamo-pituitary-adrenal axis)

Youll notice a lot of maybes, and thats partially because for one thing, theres no certainty about any of these theories. Thats why theyre called theories. For another thing, it may be multi-factorial, so there may be more than 1 right answer.

But one thing thats true for most people with fibromyalgia is that part of it is neurological (not to be confused with psychological).

There are certain neurological phenomena that happen in people with chronic pain that perpetuate the chronic pain cycle. One of those phenomena is called central sensitization. Thats an oversensitivity to stimuli that are not ordinarily painful. For instance, the feeling of silk on the skin isnt painful to most people, but it could be painful to those with chronic pain.

There are multiple strategies for dealing with central sensitization. Doctors will often use medications (SSRIs), but since I cant prescribe medications as a personal trainer, there are other effective strategies.

Here are some of the cognitive strategies that I used to help Jacqui with her pain:

Strategy 1: Sensory/Verbal Training

Jacqui is hypervigilant of any sensations going on in her body. Even insignificant sensations. But each sensation worries her, and she had one word to describe all those sensations: pain. Though it really wasnt pain that she was feeling. She just had no other words to represent or label those sensations that she was feeling. So part of her improvement came from improving her vocabulary.

When you lift weights, and your muscles start to burn, thats the discomfort of exertion, as opposed to the pain of injury. Jacqui used the word pain for both of them. I gave her a couple of different words to use for the sensation she was feeling while lifting weights: burning (as in my muscles are burning) or pump (Im feeling the pump).

Another time, she described the sensation of muscles contracting as stretching. I explained to her that what shes feeling is not stretching. Its actually the opposite. Contracting means shortening. Its literally impossible for her to feel stretching while her muscles are contracting, and in a shortened position.

So I actually had her deliberately stretch the muscle that she thought was being stretched, and notice the difference in sensations between contracting and stretching.

We had to use the right label for the right sensation.

And every time she used the word pain or hurt, I ask her is it really pain, or would another word be a more accurate representation of what youre feeling? Close to 100% of the time, she thinks about it for a few seconds, and re-labels her sensation. On a rare occasion, after thinking about it, its actually pain, in which case, we modify things. But the vast majority of the time, its not real pain. Its a mislabeled sensation.

By changing her words, she changed how she felt pain.

Strategy 2: Explaining the Neurology of Chronic Pain

               If pain is chronic, theres more than just mechanical damage going on (especially when theres no mechanical damage whatsoever X-rays, ultrasounds, MRIs, etc. cant find anything wrong). Sometimes, the pain is felt by the brain, and not the body. The brain just localizes it to a certain part of the body.

               So I explained to Jacqui that pain does not equal damage, and damage does not equal pain. Thats the simple version of it. In person, the explanation was a bit more precise, thorough, and involved diagrams. I wrote a much more detailed version of the explanation here.

               The formal name for educating a person about the mechanisms of chronic pain (which is different than acute pain) is called Therapeutic Neuroscience Education.

               The interesting thing is that study after study after study shows that just knowing the mechanisms of pain changes the pain without any hands-on therapy or exercise. So why not stack that in our favour?

Strategy 3: What She Likes About Her Body

               Chronic pain is a vicious cycle. It starts with pain that wont resolve despite the actual tissue being healed. It then progresses to this thing you unintentionally practice (yes, you can practice being in pain).

               Over time, you notice small sensations, and get worried about them. You classify them as pain (even though it might not be). Youre hypervigilant all the time for new sensations.

               How do you break out of that vicious cycle? By flooding your mind with things that you like about your body, as opposed to things you dislike about your body.

               So I had Jacqui keep a Google Sheet, where each day, she had to write down 3 things that she liked about her body. They could be very small things, like Im glad that today, I could walk for a minute at a speed of 3.9 miles per hour, without my pulse exceeding 137 bpm.

               That also took some of the edge off the pain.

Strategy 4: Distinguishing Between Subjective Sensation and Objective Performance

               One of the gifts that comes along with fibromyalgia is insomnia. You can bet that with chronic insomnia, its hard to think clearly, and you have low energy levels.

               At the beginning of every workout, Id ask Jacqui how are you feeling?, and the answer would frequently (over 80% of the time) be Im so tired/sleepy. I didnt sleep well at all last night.

               Point taken.

               Yet, we proceed with the workout as usual. I let her objective performance in the gym dictate how hard she worked that day. Because subjective feelings of energy/fatigue have almost nothing to do with objective performance.

               This is not just an observation from Jacqui, but from myself personally, and the hundreds of clients Ive worked with in the time Ive been a personal trainer (since 2006).

               Sometimes, you feel great, but your workout is well underwhelming. Sometimes you feel terrible. Lethargic, tired, and sleepy. But your workout is incredible. Other times, you feel good, and your workout is good. Other times, you feel bad and your workout is bad. So theres almost no relationship between subjective feelings of energy/fatigue, and objective performance.

               And because we write down every one of our workouts (the sets, reps, weight, and perceived exertion), this lesson was demonstrated over and over and over again, until Jacqui got the message, and really internalized it. Numbers dont lie. She made really great progress despite being tired/lethargic/sleepy over 80% of the time.

               These are just 4 of the cognitive/psychological strategies that I used with Jacqui. The cool part: 3 of those 4 took very little time. I mean, changing the word that you use for pain literally takes 10 seconds:

  1. Notice that you used the word pain or hurt
  2. Take a few seconds to think about whether that term accurately represents what youre feeling
  3. If not, find a more accurate word to use

Or writing down 3 things you like about your body. How long does that take? Well, its just 3 sentences. Most people can do that in under a minute.

But these exercises are so simple, people will often overlook the simple stuff even though it can be very powerful.

Strategies We Used to Improve Jacquis Sleep

               Besides the lethargy, low energy levels and muscle pain/tender points, one of the most bothersome things about fibromyalgia is the accompanying insomnia. Jacqui has been an insomniac for over 25 years.

               As mentioned earlier, shes tried a lot of things supplements, medications, and other tools.

               Before we worked on improving her sleep, I wanted to get a baseline of her sleep quality. So for 1 week, I had her track a few things:

  • Time she went to bed
  • Time she thought she fell asleep
  • Number of times she woke up throughout the night
  • How easy it was to fall back asleep after she woke up
  • Time she woke up in the morning
  • How fresh she felt in the morning on a 0-10 scale (0 – still tired, 10 wide awake)

And boy, when I looked at her spreadsheet, it wasnt good. She went to bed at the same time consistently, which is pretty good, but shed wake up anywhere from 2 to 30 times a night (yes, 30. Thats not a typo). Every morning, her energy would be low. Sometimes it would be easy to fall back asleep, and sometimes, shed just wake up at 4AM, unable to get back to sleep.

She was already on a bunch of sleep supplements (magnesium and melatonin) and medications.

Since she was already on a bunch of stuff, I thought Id try a breathing exercise called air hunger. Without getting into too much of the details, on how that drill works, it seemed to be effective. Not a 100% cure per se, but a definite improvement.

If she practiced that exercise, shed fall asleep in under 5 minutes. On the nights when she woke up in the middle of the night, and had a hard time getting back to sleep, if she did the air hunger exercise, shed fall asleep again in under 5 minutes.

So it addressed that part. Shes still waking up multiple times throughout the night, and feels tired when she wakes up, but the times that she feels fresh when she wakes up are becoming more frequent. Just a few days ago, she told me she had the best nights sleep in over 2 decades. That was a one-time thing for now, but encouraging, nonetheless.

I have a bunch of different strategies in my toolbox to enhance sleep, from supplements, to breathing exercises, to Bowen, and others.

But because Jacqui keeps changing around her supplements and medications all the time, its hard to find a time when shes not changing something, so we can test out my other strategies. Though Im happy with the progress shes seen with just the air hunger exercise.

Jacquis Results

               In the time that Jacqui has been working with me, her results were nothing short of extraordinary.

  • Her lat pulldowns (back and biceps) improved by 38%
  • Her overhead press (shoulders and triceps) improved by 67%
  • Her seated rows (mid-back) improved by 40%
  • Her walking speed improved by 11%
  • Her recovery in between exercises improved substantially as well

How Her Life is Different Now

               Numerical improvements in strength and endurance are nice. Theyre proxy markers that were on the right track, but the real reasons someone starts a fitness program isnt just the intellectual satisfaction that theyre doing well on a test. But rather, they want to see improvements in other areas of their life.

               So hows Jacquis life different now? A lot!

  • Shes noticing and admiring her muscles. She likes the way they look
  • In her own words from her video my legs and my waist look great!
  • Her energy levels are way better than before. She says she has so much energy on some days, she doesnt know what to do
  • The doctor from the pain clinic that shes been going to for 15 years said she can switch from coming once a month to once every 3 months
  • She can do a full day of chores, and feel fine at the end of the day. Laundry, housework, folding clothes, shopping, and playing with her cats, and she still has energy left over.
  • Jacquis never been in her words an exercise person. But now she is. She actually looks forward to going to the gym.
  • Her tender points arent as tender anymore.
  • She can walk for way longer.
  • Before, shed feel pain in her buttocks area after about 4-5 minutes of walking. Now, not at all.
  • She sleeps better. Yes, theres still room for improvement, but were making small steps in the right direction.

Is there more work left to do? Sure, but were very happy with how far Jacquis come in just 11 weeks.

If you want to get the same or similar results to Jacqui, we have a special program called Fibro Fit. To see whether you qualify for that program, just respond email me with the subject line Fibro Fit.