Warm Water Exercise


Water-based exercise is ideal for Fibromyalgia sufferers. The buoyancy provided by water makes moving easier, while the water resistance improves muscle strength in a gentle, non-impact fashion. In addition, water has soothing properties and facilitates relaxation while decreasing pain perception. Warm water is preferable to cold water because cold can cause muscle tension to worsen, something Fibromyalgia sufferers must avoid. In addition, many people with Fibromyalgia suffer from cold intolerance, therefore warm water is a more favorable option. Warm water pools are generally kept around 90 degrees Fahrenheit, slightly warmer than most conventionally-headed pools. Consult your physician or physical therapist for advice on where to locate a therapeutic warm water pool. In addition, www.findapool.com can also be used to locate a warm water pool in your location. There are typically therapy classes and warm water exercise instruction available through most facilities that offer warm water therapy pools.

Scientific Research

A 2006 study by Gusi et al. evaluated 34 women with Fibromyalgia and randomly assigned half to warm-water exercise and half to a control group that received no exercise intervention. Baseline leg and shoulder strength was measured for each participant, and quality of life and pain were measured via questionnaire and rating scales. Each measurement was taken three times: at the beginning of the study, following the three week treatment period, and after six months. The exercise group therapy consisted of training in a waist-high warm pool one hour per session, three sessions per week, for 12 weeks. Each session was divided up so that it targeted aerobic training and lower-limb strength training. Following the 12 week session, the participants in the exercise group were instructed to avoid any exercise until the next evaluation (12 weeks later). For the entire study, the control group was advised to continue their normal daily activities, which did not include any form of exercise. The researchers found that those in the exercise group made substantial gains (20% improvement) in muscle strength in their legs. In addition, health-related quality of life improved by 93% and pain was reduced by nearly 30%. No changes in strength, quality of life, or pain severity were observed in the control group (Gusi et al., 2006).

In 2009, Tomas-Carus and colleagues published findings related to an eight month randomized-controlled trial (considered the “gold standard” of research study designs) that investigated the effects of warm water exercise on health-related quality of life, balance, pain and mental health in 30 women with Fibromyalgia. The women were randomly assigned to either an exercise group (consisting of one hour sessions, three days per week, for 32 weeks), or a control group (in which participants maintained current activities of daily living that did not include any physical exercise or psychological therapy). At the end of the study, the researchers found that muscle strength and balance were greatly improved among the women in the exercise group, as was health-related quality of life, including improvements in: physical function (16% of subjects), bodily pain (58%), general health perception (33%), and mental health (52%) (Tomas-Carus et al., 2009). Another randomized controlled trial conducted in 2008 also found that twelve weeks of warm water exercise resulted in significant improvements for Fibromyalgia patients. Those randomized to three hours of warm water exercise weekly for 12 weeks showed decreases in tender point count, as well as improvements in sleep quality, cognitive function, and overall physical function (Munguia-Izquierdo & Legaz-Arrese, 2008). This same team of researchers also found improved pain control and cognitive functioning among middle-aged women with Fibromyalgia who participated in a 16 week warm water pool exercise program (Munguia-Izquierdo & Legaz-Arrese, 2007).



1.        Gusi N, Tomas-Carus P, Hakkinen A, Hakkinen K, Ortego-Alonso A. Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with Fibromyalgia. Arthrit Rheum. 2006;55(1):66-73.

2.        Tomas-Carus P, Gusi N, Hakkinen A, Hakkinen K, Raimundo A, Ortega-Alonso A. Improvements of muscle strength predicted benefits in HRQOL and postural balance in women with Fibromyalgia: an 8-month randomized controlled trial. Rheumatology. 2009;48:1147-1151.

3.        Munguia-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with Fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(12):2250-2257.

4.      Munguia-Izquierdo D, Legaz-Arrese A. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with Fibromyalgia. Clin Exp Rheumatol. 2007;25(6):823-830.

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