Exercise as the Core Treatment and a Rehab Pathway in Practice

In the 2021 EULAR recommendations, exercise is the only strong recommendation, with Cochrane support for aerobic and resistance training, weak support for hydrotherapy and recommendations against massage, manual therapy and chiropractic treatment. Graded exercise suits fibromyalgia when it does not overlap with ME/CFS. Will's group circuit offers three levels per exercise, and interviews with 11 patients who dropped out showed some were not yet ready for group work. A community class funded by Sport England continues after NHS sessions. Canadian guidance and Fibromyalgia Action UK stress active participation, pacing and early attention to poor prognostic signs such as fear avoidance, beliefs that pain is harmful and expectations of passive treatment. The Salford pathway runs from a 40 to 45 minute assessment with questionnaires, blood tests and imaging when needed to a four-part rehabilitation offer: group education, a relaxation taster, a weekly exercise group and one-to-one physiotherapy covering sleep data, education, goal setting, pacing and graded exercise. Occupational therapy, hydrotherapy and psychology referrals sit alongside, with care stratified to each patient.