I have been ill for 18 years with Fibromyalgia and ME, but have got to the stage where I think I can do more exer­cise. I used to love dan­cing but my ankles and joints are weak now – how can I strengthen them? I usu­ally over-​do any­thing new, so get knocked back quite quickly. How do I avoid that?

You are liv­ing with two debil­it­at­ing long-​term con­di­tions which we still don’t fully under­stand sci­en­tific­ally. By now, hope­fully, you have worked out how to man­age daily life in order to avoid aggrav­at­ing pain and fatigue. It will not sur­prise you if I start with a big cau­tion: make pro­gress very gently indeed. Your tend­ency to over-​do things is com­mon among people with these con­di­tions, but you will under­stand how severely you can get knocked back when you do over-​reach your­self. Self-​discipline is the key.

A return to dance can be a goal, by all means, but it will need to be a medium-​to-​long term one. First, you have to build under­ly­ing fit­ness. To start with, keep it simple. Your best exer­cise will be either walk­ing, cyc­ling or walk­ing up and down in the pool. All these activ­it­ies build heart and lung fit­ness, give you more energy, help with sleep, and start to strengthen your body, includ­ing those weak joints. With luck, you will also find your pain levels redu­cing, too.

Draw up an exer­cise chart, so you know exactly how much time you are sched­uled to do each ses­sion. Only do two ses­sions a week to start with, and only increase the amount of time by one minute a week. You will need to pick an ini­tial exer­cise time based on what you know about your own tired­ness levels, so work out that fig­ure (eg 10 minutes) – and then reduce it by at least 2 minutes to play safe!

Carry a stop-​watch so you do not exceed your max­imum time. After the exer­cise, record three things: a. how you feel; b. a score out of 10 for how hard the effort was dur­ing exer­cise, and c. your pain level (0 to 5). The next day, also record any delayed reac­tions to the ses­sion. You can learn and adjust from this valu­able inform­a­tion.

The first three months are the hard­est, because you may well get some adverse reac­tions. Use your exper­i­ence to decide whether the reac­tion is a real “knock back” or just the effect of the new and increased activ­ity. Remember, you may be doing more than you think – eg, just get­ting to the pool or park and back all rep­res­ent increased activ­ity that your body may find drain­ing.

When you get reac­tions, give your­self an extra day’s rest, then try again. If neces­sary, knock a minute off your pre­vi­ous time, to keep it man­age­able. In this tortoise-​like way, you will gradu­ally build up, aim­ing for 30 minutes’ walk (or cyc­ling etc) three times a week with no adverse reac­tions. It may take many months to achieve, but it will feel fant­astic when you get there. Then you can plan your next step towards your first ball­room dance class!