Table 1 Description of activities

1a – Therapeutic Contract / 1b-Workshop of the senses

Briefly introducing the nine steps of the program and negotiate the therapeutic contract. This contract has an objective to modulate the expectations of patients and consists of: a) define three realistic and measurable personal objectives; b) determine the lowest percentage of improvement in the clinical picture, acceptable (between 5 and 20%). According to the contract, participants also agree to devote 45 min/day, 6 days/week to practice the activities prescribed by the ISF such as relaxation techniques, diaphragmatic breathing, stretching, strengthening and aerobic exercise.

Promoting experimentation of sensory organs. Discuss the ways in which people feel and perceive the world and the reality around them. Demonstrating deep diaphragmatic breathing.

2 –Mental Preparation

Demonstrating that the environment perceptions are related to previous experience and so then perception of pain, as well as other symptoms may also be influenced by prior experience. Demonstrate some techniques of mental preparation and coping strategies to deal with the pain. Practice yoga class with emphasis on meditation. The participant will choose a relaxation technique and practice it 3 times a week for 15 to 20 min.

3 – Physical preparation

Discussing the effects of a sedentary lifestyle and physical activity. Demonstrate warm-up, stretching, strengthening and aerobic exercises. Perform calculations to identify heart rate (HR) max. Practice session of Pilates on the ground. Prescribe an exercise program to be held at home: a) exercise routine: 6 times/week, 15 min, with stretching and strengthening; b) walk, moderate 40 to 60% HR max; 3 times/week; 30 min.

4 – Stress and individuality

Studying the hypothalamic-pituitary-adrenal axis, its importance in the homeostatic systems and stress. Discussing coping strategies that contribute to the understanding and improvement of individual levels of energy / disposition (learn to say no when necessary, defer or delegate tasks at moments of suffering, be seen and be valued)

5 – Symptoms

Studying the mechanisms involved in pain, fatigue, muscle stiffness, in sleep disorders, anxiety and depression.

6 – Nutrition

Discussing the basic components of a healthy balanced diet, the benefits of hydration and the dangers provided by foods rich in sugars, fats and or sodium.

PAUSE

2 weeks of self-employment: integration of strategies individually (without meeting with therapists).

7 – Consequence of chronicity

Discussing the influence of chronic pain on the emotional, interpersonal relationships, daily activities and sexuality. Discuss aspects related to suicidal thoughts.

8 – Treatment

Presenting and discuss scientific evidence based on the main types of pharmacological and non-pharmacological treatments currently used to treat fibromyalgia.

9 – Retrospective

Motivate patients to continue the prescribed activities. Presenting a retrospective of the issues addressed.