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      Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review

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          Abstract

          Aim

          Previous systematic reviews have found hydrotherapy to be an effective management strategy for fibromyalgia syndrome (FMS). The aim of this systematic review was to summarize the components of hydrotherapy programs used in randomized controlled trials.

          Method

          A systematic review of randomized controlled trials was conducted. Only trials that have reported significant FMS-related outcomes were included. Data relating to the components of hydrotherapy programs (exercise type, duration, frequency and intensity, environmental factors, and service delivery) were analyzed.

          Results

          Eleven randomized controlled trials were included in this review. Overall, the quality of trials was good. Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component. Great variability was noted in both the environmental components of hydrotherapy programs and service delivery.

          Conclusions

          Aerobic exercise, warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes. Treatment duration of 60 minutes, frequency of three sessions per week and an intensity equivalent to 60%–80% maximum heart rate were the most commonly reported exercise components. Exercise appears to be the most important component of an effective hydrotherapy program for FMS, particularly when considering mental health-related outcomes.

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          Most cited references 22

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          The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials.

           S W Hopker,  D Lawlor (2001)
          To determine the effectiveness of exercise as an intervention in the management of depression. Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals. Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy. All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6); weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)). The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up.
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            The role of resistance exercise intensity on muscle fibre adaptations.

            Although many training variables contribute to the performance, cellular and molecular adaptations to resistance exercise, relative intensity (% 1 repetition maximum [%1RM]) appears to be an important factor. This review summarises and analyses data from numerous resistance exercise training studies that have monitored percentage fibre type, fibre type cross-sectional areas, percentage cross-sectional areas, and myosin heavy chain (MHC) isoform expression. In general, relative intensity appears to account for 18-35% of the variance for the hypertrophy response to resistance exercise. On the other hand, fibre type and MHC transitions were not related to the relative intensity used for training. When competitive lifters were compared, those typically utilising the heaviest loads (> or =90% 1RM), that is weightlifters and powerlifters, exhibited a preferential hypertrophy of type II fibres when compared with body builders who appear to equally hypertrophy both type I and type II fibres. These data suggest that maximal hypertrophy occurs with loads from 80-95% 1RM.
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              Exercise for fibromyalgia: a systematic review.

              Fibromyalgia (FM) is a syndrome expressed by chronic widespread pain often associated with reduced physical function. Exercise is a common recommendation in management of FM. We evaluated the effects of exercise training on global well-being, selected signs and symptoms, and physical function in individuals with FM. We searched Medline, Embase, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials to July 2005 and included randomized trials evaluating cardiorespiratory endurance, muscle strength, and flexibility. Methodological quality was assessed using the van Tulder and Jadad instruments. Training protocols were evaluated using American College of Sports Medicine (ACSM) guidelines. Clinical heterogeneity limited metaanalysis to 6 aerobic and 2 strength studies. There were 2276 subjects across the 34 studies; 1264 subjects were assigned to exercise interventions. Metaanalysis of 6 studies provided moderate-quality evidence that aerobic-only exercise training at ACSM-recommended intensity levels has positive effects on global well-being (SMD 0.49, 95% CI 0.23-0.75) and physical function (SMD 0.66, 95% CI 0.41-0.92) and possibly on pain (SMD 0.65, 95% CI -0.09 to 1.39) and tender points (SMD 0.23, 95% CI -0.18 to 0.65). Strength and flexibility remain underevaluated; however, strength training may have a positive effect on FM symptoms. Aerobic-only training has beneficial effects on physical function and some FM symptoms. Strength-only training may improve FM symptoms, but requires further study. Large, high-quality studies of exercise-only interventions that provide detailed information on exercise prescription and adherence are needed.
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                Author and article information

                Journal
                J Pain Res
                Journal of Pain Research
                Journal of pain research
                Dove Medical Press
                1178-7090
                2009
                30 November 2009
                : 2
                : 165-173
                Affiliations
                International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
                Author notes
                Correspondence: Saravana Kumar, International Centre for Allied Health, Evidence, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia, Tel +618 8302 2085, Fax +618 8302 2766, Email saravana.kumar@ 123456unisa.edu.au
                Article
                jpr-2-165
                3004626
                21197303
                © 2009 Perraton et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Review

                Anesthesiology & Pain management

                components, effective, exercise, fibromyalgia syndrome, hydrotherapy

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