The lifestyle change with the best evidence behind it for fibromyalgia is regular, well-chosen exercise. NHS self-help advice also covers sleep habits and relaxation, and talking therapies such as CBT or ACT can help, although the research for these is weaker. None of them cures the condition, but together they can ease symptoms and make daily life easier to manage.
What is fibromyalgia?
The NHS describes fibromyalgia as a long-term condition that causes pain all over the body. Other common symptoms include extra sensitivity to pain, muscle stiffness, poor sleep that leaves you very tired, headaches, irritable bowel syndrome and problems with concentration or memory that people call “fibro-fog”. Feelings of frustration, worry or low mood are also common.
The exact cause is unknown. The main theory is that the central nervous system (the brain, spinal cord and nerves) processes pain messages differently. Genes may play a small part, and the condition is often set off by a trigger such as a serious injury, an infection, a major operation or significant emotional stress. Sometimes there is no obvious trigger at all.
Anyone can develop fibromyalgia, but it is more common in women and usually starts between the ages of 25 and 55. The NHS says some estimates suggest nearly 1 in 20 people may be affected to some degree. That figure is uncertain because there is no specific test, and the symptoms overlap with other conditions. A GP makes the diagnosis by asking about your symptoms and ruling out other causes.
The NHS is clear that there is currently no cure. Treatment aims to ease symptoms and improve quality of life, and the symptoms are changeable: some days or weeks are better, and some are worse.
Which lifestyle changes help fibromyalgia? The big picture
People often ask for a single trick that works. The honest answer is that no single treatment works for everyone. The NHS says you may need to try a variety of approaches to find a combination that suits you, and it lists three main treatments: exercise, talking therapies and medicines.
Two major guidelines point in the same direction:
- NICE guideline NG193 (2021) covers chronic primary pain, a group that includes fibromyalgia. It recommends offering a supervised group exercise programme, and considering acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT).
- EULAR (the European alliance of rheumatology associations) 2016 recommendations evaluated 107 systematic reviews and meta-analyses. The only therapy given a “strong for” recommendation was exercise. Other options, including psychological therapies, were “weak for”, and the authors noted that the size of effect for most treatments is fairly modest.
That word “modest” matters. Lifestyle changes help many people a little to a fair amount, not everyone dramatically. A realistic goal is fewer bad days and more things you can do, rather than a pain-free life.
It also helps to know that being active, sleeping better and managing stress support each other. Poor sleep makes pain feel worse and exercise harder; gentle exercise can help sleep; stress can trigger flare-ups. For the wider picture of how habits add up, see our guide to why a healthy lifestyle matters.
Exercise: the best-supported lifestyle change
It sounds unfair. When you are in pain and exhausted, being told to exercise is the last thing you want to hear. But the NHS states that regular exercise has been shown to help reduce pain and improve overall quality of life in fibromyalgia, and exercise is the one therapy EULAR rated “strong for”. The key is the right kind, at the right level, increased slowly.
The NHS says the type of exercise should be something you enjoy and can keep doing long term. Your GP or physiotherapist may be able to refer you to a specialist or a supervised programme, and the plan may include aerobic exercise, strengthening exercise, or both.
Aerobic exercise (walking, cycling, swimming)
Aerobic exercise raises your heart rate gently for a sustained period. A Cochrane review of 13 randomised trials (839 people) found moderate-quality evidence that aerobic exercise probably improves health-related quality of life. Lower-quality evidence suggested it may slightly reduce pain and slightly improve physical function, with little difference in fatigue or stiffness.
The reviewers said aerobic exercise appeared to be well tolerated, because a similar share of people dropped out of exercise and non-exercise groups, but that safety evidence was thin because few studies measured side effects. In other words: it helps modestly, and most people can do it, but it is worth building up carefully.
Strength (resistance) exercise
Strength work means moving against resistance, such as light weights, elastic bands or your own body weight. A Cochrane review of five small studies (219 women) found low-quality evidence that moderate to higher-intensity resistance training improved overall function, pain, tenderness and muscle strength. Low-quality evidence also suggested that women with fibromyalgia can safely do moderate to high-resistance training.
“Low quality” means we should not be too confident, because the studies were few and small. This is why NICE and the NHS talk about plans tailored to the individual rather than one fixed routine.
Mixed exercise programmes
Many real-life programmes combine aerobic, strength and flexibility work. A 2019 Cochrane review of 29 trials (2,088 participants) found moderate-quality evidence that mixed exercise probably improves quality of life, physical function and fatigue compared with no exercise. It cautioned that for some people the improvement may be small.
Exercising in water
Warm-water exercise takes weight off sore joints and muscles, which many people find easier to start with. A Cochrane review of 16 studies (881 people) found low to moderate quality evidence that aquatic training is beneficial for wellbeing, symptoms and fitness compared with no exercise. Land-based and water-based programmes gave similar results for pain and function, although this comparison rested on very low to low quality evidence and land-based training was better for muscle strength, so the best choice is the one you will actually keep doing. No serious side effects were reported.
Evidence at a glance
| Type of exercise | What Cochrane reviews found | Evidence quality |
|---|---|---|
| Aerobic (walking, cycling) | Probably improves quality of life; may slightly reduce pain | Moderate for quality of life, low for pain |
| Strength | Improved function, pain, tenderness and strength | Low |
| Mixed programmes | Probably improve quality of life, function and fatigue (may be small) | Moderate |
| Aquatic (water-based) | Beneficial for wellbeing, symptoms and fitness | Low to moderate |
If you find it hard to get moving, our article on how to motivate yourself to exercise has practical ideas, though with fibromyalgia the advice is always to start low and go slow.
Tai chi, yoga and other gentle movement
Many people with fibromyalgia are drawn to slower, mind-and-body styles of movement. The evidence here is thinner than for ordinary exercise, so it is worth being precise about what is known.
Tai chi
The strongest single study is a US randomised trial published in the BMJ in 2018. It followed 226 adults with fibromyalgia who were assigned to supervised aerobic exercise or to one of four tai chi programmes. Everyone improved, but the tai chi groups improved slightly more on the main symptom questionnaire at 24 weeks (a difference of 5.5 points).
That is encouraging, but it is one trial, run in one hospital, so it does not prove tai chi beats every other exercise. It does suggest that gentle, slow movement is a sensible option if walking or cycling does not appeal.
Yoga, stretching and other movement therapies
Yoga is popular and many people report that it feels good. But when the Cochrane review of mind and body therapies (61 trials, 4,234 people) looked at movement therapies, mindfulness, relaxation and biofeedback, it concluded that their effectiveness remained unclear, because the evidence was low or very low quality. “Unclear” is not the same as “useless”. It means we need better studies.
If you enjoy yoga, a stretch class or gentle pilates, check with your GP first, work at your own pace and tell the instructor about your condition. Our comparison of pilates, yoga, tai chi and qi gong explains how these styles differ, and our guide to the benefits of yoga covers the general (not fibromyalgia-specific) research.
How to start exercising with fibromyalgia
The NHS and NICE both say the plan should fit your abilities, preferences and health needs. These practical points reflect that approach, but your GP or physiotherapist can tailor them to you.
- Ask for a plan. The NHS says your GP or physiotherapist may refer you to a health professional who specialises in helping people with fibromyalgia plan exercise. NICE recommends a supervised group programme.
- Choose something you enjoy. If you dislike it, you will not keep it up, and long-term consistency is what the NHS emphasises.
- Start small. A few minutes of walking or a short swim is a perfectly good start. Gradually build up over weeks, not days.
- Listen to your body. If a session leaves you in much more pain or exhausted for days, tell your GP or physiotherapist so the plan can be adjusted.
- Review it. Symptoms change, so ask your GP or physiotherapist to adjust the plan if it stops suiting you.
Pacing: balancing activity and rest
Pacing means planning your day so that you do not do too much on a good day and then pay for it with days of pain and exhaustion. It is a widely taught self-management idea in pain services. Typical pacing habits include:
- breaking big jobs into smaller steps;
- alternating activity with short rests;
- putting the most demanding tasks at the time of day when you usually feel best;
- doing a little each day instead of everything at once.
An honest note: the NHS fibromyalgia pages and the guidelines above do not name pacing as a stand-alone treatment, and we found no strong trial evidence for pacing on its own. We include it because it is a common-sense way of putting the “exercise little and often” advice into practice, and because it is a technique many people are taught in pain services. Treat it as a tool to try, not a proven cure.
Sleep: why it matters and what helps
The NHS notes that fibromyalgia can make it difficult to fall asleep or stay asleep, and poor sleep can leave you very tired. Because tiredness is one of the main symptoms, sleep habits are one of the lifestyle areas most worth working on.
NHS self-help advice for sleep includes:
- getting up at the same time every morning;
- trying to relax before going to bed;
- creating a bedtime routine, such as a bath and a warm, milky drink every night;
- avoiding caffeine, nicotine and alcohol before bed;
- avoiding a heavy meal late at night;
- making sure your bedroom is comfortable, quiet and dark;
- avoiding checking the time throughout the night.
Our articles on sleep hygiene and mental health and the effects of sleep deprivation explain why a regular routine helps for everyone, not only people with fibromyalgia.
Some talking therapies may also help. The NHS says acceptance and commitment therapy (ACT) has been shown to improve sleep quality as well as reduce pain. Certain antidepressants can improve sleep too, but that is a decision to make with a doctor, not something to start yourself.
Try it: a one-week sleep routine
Tick off each step as you build your routine. Your ticks are saved in your own browser.
- Pick a wake-up time and stick to it, including weekends
- Choose a short wind-down routine, such as a bath or reading
- Cut caffeine, nicotine and alcohol close to bedtime
- Keep the bedroom comfortable, quiet and dark
- Avoid a big meal late in the evening
- Turn the clock around or avoid checking the time overnight
- If sleep stays poor after a few weeks, book a chat with your GP
Stress management and talking therapies
The NHS says that stress can make fibromyalgia symptoms worse or cause them to flare up more often, and that it could increase the chance of developing depression. That is why relaxation and emotional wellbeing sit alongside exercise in NHS self-help advice. This is not saying the condition is “all in the mind”. Pain is real, and it is influenced by both body and brain.
Everyday relaxation
The NHS suggests taking time each day to do something that relaxes you, and says that deep-breathing techniques or meditation may be just as effective as the books, tapes and courses sold for relaxation. Relaxing before bed may also help you sleep better. For general ideas, see our guide to a stress-free life.
Be realistic about mindfulness. Many people enjoy it, but the Cochrane mind and body review found no clear advantage for mindfulness over usual care for pain, physical function or mood, based on the studies available. It can still be a pleasant way to unwind, as long as you do not expect it to treat the condition.
Talking therapies: ACT and CBT
These are the best-supported psychological options. NICE says to consider ACT or CBT for chronic primary pain (aged 16 and over), delivered by appropriately trained professionals. The NHS explains the two approaches this way:
- Acceptance and commitment therapy (ACT) helps you accept what is out of your control and commit to making changes that improve your life. The NHS says it has been shown to improve sleep quality, reduce pain and help deal with negative thoughts and feelings.
- Cognitive behavioural therapy (CBT) helps you manage problems by changing the way you think and behave. The NHS says it can improve quality of life for people living with long-term pain.
The Cochrane review found low-quality evidence that psychological therapies had favourable effects on physical functioning, pain and mood compared with usual care. The effects were small, and there was very low quality evidence that more people dropped out of therapy groups than usual care. So therapy is not magic, but it is one of the few non-drug options that guidelines support.
You can ask your GP about referral. Waiting times and availability depend on where you live. If low mood, worry or stress are affecting daily life, tell your GP, because anxiety and depression can occur alongside fibromyalgia and can be treated.
Support groups and staying connected
The NHS says support groups can provide an important network, and that just talking to someone who knows what you are going through can make you feel better. The UK charity Fibromyalgia Action UK offers information and support, and its regional co-ordinators can put you in touch with local groups. At the time of the NHS page (reviewed October 2022), its helpline was 0300 999 3333, open Monday to Friday, 10am to 4pm. Check the charity’s website for current details.
Family and friends can also help. Telling people what the condition is like, including that symptoms can change from day to day, makes it easier for them to understand why you sometimes need to cancel plans.
Diet and weight: what the evidence says
Is there a fibromyalgia diet?
Many websites promise special diets. The research does not support those promises. A 2020 systematic review of 22 studies of dietary changes in fibromyalgia found some small studies reporting less pain with particular diets (for example vegan and low-FODMAP diets), but the studies were often poor in quality, small and varied. The authors concluded there is insufficient evidence to recommend any one nutritional intervention for fibromyalgia.
The NHS fibromyalgia pages do not recommend a specific diet either. So the sensible, evidence-based position is: eat a balanced, varied diet because it is good for your general health, and be sceptical of anyone selling a cure. Our guide on why we need a balanced diet covers the basics. If you are thinking about cutting out a whole food group, talk to your GP or a registered dietitian first, so you do not miss important nutrients.
What about body weight?
A 2021 systematic review found that obesity is common in people with fibromyalgia (about 36% in the pooled studies) and that higher body weight was linked, weakly on average, with worse symptoms such as pain, fatigue and poor sleep. The few studies of weight loss gave preliminary evidence that it may ease symptoms, but the overall quality was low, and the authors still recommended weight management. This is not a reason for blame, and the links found were weak. If weight is a concern, discuss it with your GP; our article on lifestyle changes for weight loss gives general advice.
What does not have good evidence?
Because fibromyalgia is difficult to live with, it attracts many costly products. Here is what the UK guidance says about some common approaches.
- Supplements and “miracle” cures. None of the sources used for this article supports a supplement as a treatment for fibromyalgia. The 2020 diet review mentioned small, low-quality studies of a few supplements, but concluded the evidence was insufficient. Please speak to a pharmacist or GP before taking any, especially alongside prescribed medicines.
- Acupuncture. The NHS says it can reduce pain in some people with long-term pain, but the effects have only been shown to last up to 3 months. NICE suggests it can be considered only within set conditions, in a single course.
- Heat, cold, posture aids and assistive devices. These appear on many lists, but none of the guidelines we checked made a recommendation about them. Some people find a warm bath soothing, and the NHS includes a bath in its bedtime example, but that is comfort rather than proven treatment.
No guideline or review above supports nitric oxide boosters or L-arginine supplements as a treatment for fibromyalgia.
Quick check: according to the EULAR 2016 review, which treatment type was rated “strong for”?
Exercise. The other therapy types were rated “weak for” based on the available meta-analyses.
Which two talking therapies do NICE and the NHS mention for long-term pain?
Acceptance and commitment therapy (ACT) and cognitive behavioural therapy (CBT).
Working with your GP: building a plan that suits you
The NHS says your GP can help you decide on the best treatment for you, depending on what you prefer and what is available in your area. Lifestyle changes work best as part of a plan, not as a lone effort.
Things worth discussing at an appointment:
- Exercise: whether you can be referred to a physiotherapist or a supervised programme, as the NHS and NICE describe.
- Talking therapies: whether ACT or CBT is available locally, and how long the wait might be.
- Sleep, mood and stress: especially if they are getting worse or affecting work, study or family life.
- Medicines: including any you already take, and any over-the-counter products or supplements.
- Work or school: adjustments that might help you keep going, such as flexible breaks.
It may help to keep a short diary for a couple of weeks noting pain, sleep, activity and mood. Bring it with you. It gives your GP concrete information instead of relying on memory, and it can show which days are better or worse.
Medicines and other treatments, briefly
This article is about lifestyle, but you should know the medical side exists. The NHS says antidepressants are sometimes used to help relieve the pain of fibromyalgia and can also help sleep, emotional health and quality of life. NICE lists amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine and sertraline as options to consider for adults, after a full discussion of benefits and harms. The NHS also says there is little or no evidence that other types of medicine help reduce long-term pain.
These decisions belong to you and your doctor. Do not start, stop or change a medicine because of something you read online, including here.
Putting it together: a sustainable plan
The NHS stresses that what works for one person may not work for another. A good plan is simple, personal and flexible, and symptoms can fluctuate, so some weeks you will do less. That is normal and not a failure.
A realistic way to begin:
- Pick one change to start with, such as a regular wake-up time or a short daily walk.
- Do it for two weeks before adding something else.
- Use a diary to see what helps.
- Review the plan with your GP or physiotherapist.
When to seek help
Test yourself
Flip the cards
Frequently asked questions about fibromyalgia and lifestyle changes
What lifestyle changes help fibromyalgia the most?
Regular, suitable exercise has the strongest evidence. The NHS says it has been shown to reduce pain and improve quality of life. Sleep habits and relaxation are part of NHS self-help advice, and talking therapies such as CBT or ACT are commonly advised, although the evidence for these is weaker. Results vary, so a plan should be tailored to you with your GP.
Can fibromyalgia be cured with lifestyle changes?
No. The NHS says there is currently no cure for fibromyalgia. Lifestyle changes and treatments aim to ease symptoms and improve quality of life. Symptoms can still change from week to week, and they are unlikely to disappear completely, so be wary of anyone promising a cure.
What is the best exercise for fibromyalgia?
There is no single best type. Cochrane reviews found benefits for aerobic, strength, mixed and water-based exercise, and a single 2018 trial found tai chi improved symptoms slightly more than aerobic exercise. The NHS advises choosing something you enjoy and can keep doing, and asking your GP or physiotherapist about an exercise plan.
Is walking good for fibromyalgia?
Walking is a form of aerobic exercise, and a Cochrane review found moderate-quality evidence that aerobic exercise probably improves quality of life. Start with short, comfortable walks and increase gradually. If walking makes your pain much worse, tell your GP or physiotherapist.
What should I eat if I have fibromyalgia?
There is no proven fibromyalgia diet. A 2020 systematic review found insufficient evidence for any single dietary approach. Aim for a balanced, varied diet for general health. Speak to your GP or a dietitian before cutting out food groups or taking supplements.
How can I sleep better with fibromyalgia?
The NHS suggests getting up at the same time each morning, relaxing before bed, keeping a bedtime routine, avoiding caffeine, nicotine, alcohol and heavy late meals, and keeping the bedroom comfortable, quiet and dark. If problems persist, speak to your GP.
Does stress make fibromyalgia worse?
The NHS says stress can make symptoms worse or cause them to flare up more often. Relaxation, deep breathing, meditation and talking therapies may help you manage stress. Your GP can advise on counselling or other support if stress, anxiety or low mood are affecting you.
Do tai chi and yoga help fibromyalgia?
One 2018 trial of 226 adults found tai chi improved symptoms slightly more than aerobic exercise at 24 weeks. For yoga and other movement therapies, a Cochrane review found the evidence unclear because of low quality. They are reasonable options if you enjoy them and check with your GP.
Which medicines are recommended for fibromyalgia?
The NHS says antidepressants such as amitriptyline, duloxetine and sertraline are sometimes used to relieve pain and improve sleep. NICE advises against starting opioids, NSAIDs, paracetamol and several other drugs for chronic primary pain. Always discuss medicines with your doctor.
When should I see a GP about fibromyalgia?
See a GP if you think you have fibromyalgia, or if your pain, tiredness or sleep problems are getting worse or affecting daily life. The NHS says there is no specific test, so your GP will assess your symptoms and rule out other conditions.
