Exercise enables patients to capitalize on the increased metabolic capacity provided by the combination of thyroid hormone and nutritional supplements. Resistance exercises contribute to the increase in metabolism by increasing muscle mass. Muscle has a higher metabolic rate than fat, so increasing muscle mass by resistance exercises increases the metabolic rate. Aerobic exercise also contributes to the increased the metabolic rate. For most patients, the most important forms of physical treatment are trigger point therapy and spinal manipulation.
Physical treatment is essential for some patients' pain scores to continue to decline.
With effective physical treatment, most patients eventually no longer meet the pain criteria for fibromyalgia.