Objectives Clinical Assessments and Interventions Referral for Medical Action 84 and conservatively and building up tolerance to exercise incremen- tally. Low-impact aerobic exercise prevents muscle atrophy promotes blood circulation, enhancing oxy- gen and nutrient flow to muscles and connective tissue and im- proves strength and endurance. Ex- amples include walking, water aerobics, and the use of stationary equipment such as bicycles and treadmills. Local fitness and recre- ational centers may offer exercise programs designed specifically for fibromyalgia and other chronic pain conditions. Discuss work and personal time- management techniques for avoid- ing overexertion and/or emotional stress. Assist in developing a plan to en- sure adequate sleep because fa- tigue is one of the main effects of fibromyalgia. Discuss nutritional intake and have the employee maintain a food diary for several days to weeks. Avoiding caffeine may improve sleep patterns and lessen symp- toms. Also, balanced nutrition helps stabilize blood-sugar levels and increase energy for daily ac- tivities and exercise. Refer to the guidelines listed in guideline on nutrition on page 271. Review the diary with the employee. Consider the need for referral to a dietitian. Evaluate the major functions of the job to determine whether accommo- dations are necessary. Provide factual information on alter- native therapies, if appropriate, and ensure that the employee is commu- nicating with the personal health care provider regarding other treatment modalities, such as acupuncture, trigger-point injections, and massage. Discuss the need for support ser- vices and provide information on support groups in the area. Monitor for depression and refer for medical evaluation and treatment as necessary. of warm soaks when at home for 20 to 30 minutes, as needed, if symptom relief is provided. Guideline continues on next page
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