Fibromyalgia

NUTRITION

• A low FODMAP diet may reduce symptoms, particularly FM patients with irritable bowel syndrome (7)

• Vitamin D: Limited evidence suggests that supplementation / adequate levels may reduce symptoms (5)

• There is some evidence that a plant based diet may reduce symptoms of fibromyalgia (6)

PHYSICAL ACTIVITY

• Regular physical activity / exercise is the only therapy with a strong recommendation (2)

• Activities that combine exercise with relaxation training is effective (1)

• Both aerobic exercise and resistance training are associated with improved pain and physical function (2)

• Both land based and water based exercise are effective (3)

• Pain may increase in the beginning of an exercise program. Thus, it is important to motivate the patient to continue the program, preferrably sligt to moderate intensity 2-3 times per week (3)

• Regular aerobic exercise may possibly also reduce fatigue and stiffness (4)

STRESS

• Stress may increase fibromyalgia symptoms. Thus learning stress management is useful (8)

SLEEP

• Most people with fibroomyalgia have non restorative sleep (9)

• Maintain good sleep hygiene (8)

• Low quality evidence shows that among people with fibromyalgia cognitive behavior therapy for insomnia (CBT-I) improves sleep quality, pain, anxiety, depression, but not sleep efficiency compared to other non-pharmacological treatments (10)