Exercise Therapy for Fibromyalgia

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Abstract

Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction, and other somatic symptoms, negatively impacts physical and emotional function and reduces quality of life. Exercise is commonly recommended in the management of people with fibromyalgia, and interest in examining exercise benefits for those with the syndrome has grown substantially over the past 25 years. Research supports aerobic and strength training to improve physical fitness and function, reduce fibromyalgia symptoms, and improve quality of life. However, other forms of exercise (e.g., tai chi, yoga, Nordic walking, vibration techniques) and lifestyle physical activity also have been investigated to determine their effects. This paper highlights findings from recent randomized controlled trials and reviews of exercise for people with fibromyalgia, and includes information regarding factors that influence response and adherence to exercise to assist clinicians with exercise and physical activity prescription decision-making to optimize health and well-being.

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Most cited references 36

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Effect of a self-management program on patients with chronic disease.

K Lorig, D S Sobel, P Ritter … (2002)

For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. To evaluate outcomes of a chronic disease self-management program in a real-world" setting. Before-after cohort study. Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data. The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building. Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires. At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant. We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.

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A randomized trial of tai chi for fibromyalgia.

Ramel Rones, Fernando Goldenberg, Yoojin Lee … (2010)

Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia. We conducted a single-blind, randomized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia (defined by American College of Rheumatology 1990 criteria). Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the study groups. The primary end point was a change in the Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 to 100, with higher scores indicating more severe symptoms) at the end of 12 weeks. Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). All assessments were repeated at 24 weeks to test the durability of the response. Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (+/-SD) baseline and 12-week FIQ scores for the tai chi group were 62.9+/-15.5 and 35.1+/-18.8, respectively, versus 68.0+/-11 and 58.6+/-17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group, -18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5+/-8.4 and 37.0+/-10.5 for the tai chi group versus 28.0+/-7.8 and 29.4+/-7.4 for the control group (between-group difference, 7.1 points; P=0.001), and the mental-component scores were 42.6+/-12.2 and 50.3+/-10.2 for the tai chi group versus 37.8+/-10.5 and 39.4+/-11.9 for the control group (between-group difference, 6.1 points; P=0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, -18.3 points; P<0.001). No adverse events were observed. Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations. (Funded by the National Center for Complementary and Alternative Medicine and others; ClinicalTrials.gov number, NCT00515008.)

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Identifying the clinical domains of fibromyalgia: contributions from clinician and patient Delphi exercises.

Roderick Williams, P J Mease, Leslie Crofford … (2008)

In evaluating the effectiveness of fibromyalgia (FM) therapies, it is important to assess the impact of those therapies on the full array of domains considered important by both clinicians and patients. The objective of this research was to identify and prioritize the key clinically relevant and important domains impacted by FM that should be evaluated by outcome assessment instruments used in FM clinical trials, and to approach consensus among clinicians and patients on the priority of those domains to be assessed in clinical care and research. Group consensus was achieved using the Delphi method, a structured process of consensus building via questionnaires together with systematic and controlled opinion feedback. The Delphi exercises involved 23 clinicians with expertise in FM and 100 patients with FM as defined by American College of Rheumatology criteria. The Delphi exercise revealed that the domains ranked most highly by patients were similar to the domain rankings by clinicians. Pain was consistently ranked highest by both panels. Fatigue, impact on sleep, health-related quality of life, comorbid depression, and cognitive difficulty were also ranked highly. Stiffness was ranked highly by patients but not clinicians. In contrast, side effects was important to clinicians but was not identified as important in the patient Delphi exercise. The clinician and patient Delphi exercises identified and ranked key domains that need to be assessed in FM research. Based on these results, a conceptual framework for measuring patient-reported outcomes is proposed.

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Author and article information

Contributors

: angela.busch@usask.ca

Journal

Journal ID (nlm-ta): Curr Pain Headache Rep

Title: Current Pain and Headache Reports

Publisher: Current Science Inc. (New York )

ISSN (Print): 1531-3433

ISSN (Electronic): 1534-3081

Publication date (Electronic): 5 July 2011

Publication date PMC-release: 5 July 2011

Publication date (Print): October 2011

Volume: 15

Issue: 5

Pages: 358-367

Affiliations

[1 ]School of Physical Therapy, University of Saskatchewan, 1121 College Drive, Saskatoon, Saskatchewan S7N 0W3 Canada

[2 ]Cochrane Musculoskeletal Group & CIHR-IMHA Knowledge Exchange Task Force, 229 Bessborough Avenue, Moncton, New Brunswick E1E 1R3 Canada

[3 ]Community Health & Epidemiology, University of Saskatchewan, 501-121 Research Drive, Saskatoon, Saskatchewan S7N 1K2 Canada

[4 ]218 Buckwold Cove, Saskatoon, Saskatchewan S7N 4V9 Canada

[5 ]School of Physical Therapy, University of Western Ontario, 1201 Western Road, London, Ontario N6G 1H1 Canada

[6 ]3355 Robinson Road, North Vancouver, British Columbia V7J 3P7 Canada

[7 ]London Health Sciences Centre, 339 Windermere Road, London, Ontario N6A 5A5 Canada

Article

Publisher ID: 214

DOI: 10.1007/s11916-011-0214-2

PMC ID: 3165132

PubMed ID: 21725900

SO-VID: a55c3ea9-8141-4a44-b534-e8eb6451aca3

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: strengthening,physical activity,fibromyalgia,exercise prescription,nordic walking,exercise,yoga,randomized control trial,aquatics,tai chi,aerobics,pain management,exercise progression,nonpharmacologic therapy,adults,flexibility,cognitive behavioral therapy,pain,pilates,review article,fatigue,vibration

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: strengthening, physical activity, fibromyalgia, exercise prescription, nordic walking, exercise, yoga, randomized control trial, aquatics, tai chi, aerobics, pain management, exercise progression, nonpharmacologic therapy, adults, flexibility, cognitive behavioral therapy, pain, pilates, review article, fatigue, vibration

Exercise Therapy for Fibromyalgia

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Most cited references 36

Effect of a self-management program on patients with chronic disease.

A randomized trial of tai chi for fibromyalgia.

Identifying the clinical domains of fibromyalgia: contributions from clinician and patient Delphi exercises.

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