Q: I have fibromyalgia as well as osteoarthritis (OA). I would like to do some exercises to regain muscle mass and improve flexibility, but weight-training leaves me with worse pain. What do you recommend?

A: Many of my fibromyalgia patients tell me their pain worsens when they exercise – particularly if they are just starting an exercise program. The truth is that you will have to stick with an exercise program for about six weeks, exercising two or three times per week, to start feeling or seeing any benefit.

Don't start a program while your fibromyalgia is flaring ­– wait until you're at your usual baseline. Then start slowly, giving yourself a day or two between workouts. If you can stick it out, I think you'll find the benefits of exercise worth the temporary increase in discomfort.

Start with lots of range-of-motion work, taking each joint through its full range of motion five to eight times. Continue your exercise session by walking in a warm pool, if you have access to one. If you don't have access to a pool, walking on land is acceptable, as is using an exercise bicycle or elliptical trainer. I don't recommend stair-climbers or running at this stage. The goal is to get your heart and lungs in shape and get the blood flowing to your muscles and joints.

After three to four weeks, add weight training, but instead of doing a lot of repetitions (reps) with a low weight, consider doing fewer reps (no more than six to eight at a time) with a higher weight. Aim for three sets of reps two to three times a week for each muscle group. How fast you progress depends on how you feel, and you have to judge for yourself if you feel you've overdone it.

In general, if it hurts when you do the exercise, you should back off on the intensity or the number of reps. However, feeling sore a day or two after exercise is often the normal response to muscles being challenged; as your muscles become conditioned to exercise, the soreness should diminish. A prolonged increase in pain, however, could be a sign you've done too much too soon and you should cut back to just range-of-motion and stretching exercises.

Ronenn Roubenoff, MD, Rheumatologist