Class Flow

EXAMPLE

Modifications Specific to FM

Full Body Warm Up: 5 minutes

Purpose: A gradual progression of gentle rhythmic movement, designed to stimulate the neuromuscular system and metabolic pathways, and elevate core body temperature.

Begin Standing:

--March in place--Add close-to-body alternating arm swings--Change to small step touches side to side--Add alternating backward shoulder rolls--Change to two small steps right, two left--Add low dual arm side lifts--March in place--Add close-to-body alternating arm swings--Change to alternating heels front--Add dual biceps curls--Change to alternating front knee lifts--Add alternating forward arm lifts--Change to march in place--Add close-to-body alternating arm swings--Change to alternating curl backs--Add low, dual arm bent elbow press-backs

If the room temperature is set at about 70 degrees, warmer than a typical fitness studio, this will be ideal for this workout.

Avoid overhead arm work and movements that keep the limbs away from the body's centerline for extended periods.

Allow participants to modify the movements to accommodate their areas of pain on any given day.

Alignment Work: 5-minutes

Purpose: Retrain the body to become aware of the feeling of good body alignment.

Begin Standing:

--To center weight evenly between the heels and balls of the feet, rock forward and back from toes to heels. End with weight evenly distributed across the bottoms of the feet.--To align legs, bend and straighten the knees. End by gently softening knees. --To align the pelvis, move the tailbone to the front and then the back. End with a release from a forward-tucked tailbone. --To align the torso, lower and lift the ribcage away from the floor. End with a lift toward the ceiling and then let the ribcage relax. --To align the shoulders, move them forward and backward, End with shoulders back and down.--To align head over shoulders, pull the chin back so the entire head moves toward the back wall. End by releasing and relaxing.

For those experiencing hip and leg pain, the alignment work can be modified by sitting tall in a chair, beginning at torso alignment instruction.

Participants may express surprise that good alignment feels so uncomfortable at the beginning. The analogy of learning to ride a bike might help: Although awkward at first, learning to coordinate each motion is necessary for success and will eventually feel natural.

Have participants maintain their corrected alignment throughout the breathing section that follows.

Breath Work: 5 minutes

Purpose: Retraining breathing patterns will be a key success factor when beginning endurance activities that require increased oxygen.

Seated on a chair or standing:

Touch the abdomen below the navel --Breathe in and have the abdominal wall relax and rise --Breathe out and feel  the abdominal wall move back, toward the spinal column.

Place hands on each side of the ribcage--Breathe in and have the chest wall move toward the right and left walls--Breathe out and let the chest move back to the center.

Place hands over the collarbones--Breathe in and have the collarbones and shoulder blades lift upward-- Breathe out and return to the starting point.

Advise class members to practice proper breathing techniques outside of class, several times per day, until it feels natural.

A take-home handout with the directions at left will be helpful for participants with "Fibro-Fog" cognitive issues.

Flexibility Work: 20 minutes

Purpose: Adding ROM and improved flexibility to tight muscles works in conjunction with alignment awareness to decrease abnormal postures.

Seated on a chair or working on a comfortable mat, stretch the following muscles while maintaining good postural alignment:

• the splenius and mastoids
• the anterior deltoids
• the trapezius
• the pectorals
• the IT band and piriformis
• the iliopsoas and quadriceps
• the hamstrings
• the gastrocnemius and soleus
• the plantar fascia

NOTE: For major pain and stiffness, an appointment with a physical or occupational therapist may be needed to help stretch specific muscle groups. For example, the "Spray and Stretch" technique may be needed to unlock certain areas. This specific work is beyond the scope of what can be provided in a group setting.

Do not hold flexibility poses longer than 10-seconds. Instead, alternate limbs when possible, and perform several shorter poses.

Eliminate overhead flexibility movements, whenever possible by positioning supine on mats for overhead stretches.

A percentage of persons with FM are hypermobile. If this is the case, they should model the leader for safe positioning instead of moving until a stretch is felt.

Mind Relaxation: 10 minutes

Purpose: There is increased sympathetic nervous system activity due to heightened pain levels in FM. Relaxation techniques are valuable for reducing the resulting stress response.

Seated on a chair or supine on a comfortable mat:

Without tightening muscles, call attention to the following body areas:

Toes--Tops and soles of feet--Heels--Ankles--Lower legs--Knees--Thighs--Backside--Hips--Lumbar spine--Thoracic spine--Cervical spine--Shoulders--Upper Arms--Elbows--Forearms-- Wrists--Tops and palms of hands--Fingers--Place hands over belly--Belly--Chest--Collarbones--Neck--Jaw--Lips--Cheekbones--Eyes--Forehead

Briefly remind participants to soften the belly and allow abdominals to rise gently with each inhale.

Ask participants to relax each body area that is mentioned, using exhalations as the relaxation trigger.