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What is fibromyalgia syndrome (FMS) and how can exercise help?
Fibromyalgia Syndrome is a syndrome of widespread
body pain. People with FMS often feel tired, stiff, anxious, and cannot
get a good night's sleep. Research has shown that many people with FMS
have less physical endurance than others. These low levels of fitness may
be due to the pain, fatigue and depression of FMS, but research suggests that
people with FMS are able to exercise and that exercise may improve overall
fitness, as well as help reduce pain and improve symptoms.
How did the scientists find the information
and analyse it?
The scientists working with the Cochrane
Musculoskeletal Group searched scientific journals for studies testing exercise
in people with FMS. Not all studies found were of a high quality and so only
those studies that met the high standards of the Cochrane Collaboration were
selected.
The studies selected to include in this summary had
to meet the following scientific standards:
- studies had to be randomised trials - studies that
compare patients who exercised to patients who did not exercise or who
received a different treatment
- the studies had to show how well exercise works and its safety by using
accepted measurements
Which high quality studies were included in
the summary?
Studies that tested aerobic performance, strength,
flexibility or any combination of these exercises in patients who were diagnosed with
FMS by medical criteria were included. Sixteen studies were found and tested a
total of 724 FMS patients, most of whom were women and between the ages of 31
and 55. The average number of patients in the smallest groups who
exercised in each of the sixteen studies was 16.
Most of the conclusions from the summary are based on
seven of the sixteen studies that were very high quality.These studies
included exercises that met the American College of Sport Medicine guidelines
for improving physical fitness. These guidelines require that
aerobic exercises are for at least 20 minutes continuously or
spread throughout the day for 2 days per week for 6 weeks and achieve a specific
heart rate; strength exercises are for 2-3 days per week and
include at least one set of 8-12 repetitions for each exercise; and
flexibility exercises are to a position of mild discomfort and
include 3-4 repetitions of each stretch for 10-30 seconds at least 2 days per
week.
- There
were four studies that tested aerobic exercises including cycling, walking,
whole body or dance aerobics over 6 to 20 weeks (2 studies tested at 2 or 4.5
years also).
- There
was one study that tested strength exercises including squats, knee and trunk
extensions and bench presses, over 21 weeks.
- There was one study that tested an
aerobic programme (walking), strength and flexibility exercises over 6 weeks.
- There were two studies that tested a combination
of exercise and another treatment: aerobic exercise plus education and aerobic
exercise plus biofeedback (this last study was also one of the four aerobic
studies listed above).
Did symptoms improve with exercising?
- Aerobic exercises after 6 to 20
weeks
- aerobic fitness/performance
improved on average by 17% in patients who did aerobic exercises and 0.5% in
patients who did not - thresholds to pain improved on average by 28% in
patients who did aerobic exercises but became worse by 7% in patients who did
not
- pain intensity decreased on average by 11% in patients who did
aerobic exercises but increased by 1.6% in patients who did not
- overall
well-being improved in patients who did aerobic exercises
- sleep,
fatigue, sense of well-being, confidence in performing tasks and physical
function improved in some studies but did not in other studies
- psychological function, such as depression or anxiety, improved equally in patients who
exercised and in patients who did not
- Strength exercises after 21 weeks (results from one
study)
- pain, muscle fitness and mood improved in patients
who did strength exercises more than in patients who did not - sleep and fatigue changed about equally in patients who
exercised and in patients who did not
- Combined exercise programme after 6 weeks (results
from one study):
- aerobic fitness and thresholds to pain improved more
in patients who had a combined exercise programme compared to patients who did
not
-
Aerobic exercise and education or biofeedback:
- there were no differences between the patients who exercised with biofeedback or without biofeedback
There were three studies that tested exercises for longer
than 21 weeks - two were able to follow the patients during that time. One
study showed that patients reported better physical function and greater
confidence in performing daily tasks after 1 year of exercise; and the other
study showed that patients who exercised for 6 months had greater confidence in
performing daily tasks, less fatigue and showed more improvement in the 6-minute
walk test (a test for the ability to do activities of daily life) than patients
who did not exercise.
Did people with FMS have any difficulties
during or after exercising?
Many of the studies did not clearly
report whether difficulties occurred or did not occur. Some studies
reported that patients complained of increased symptoms of FMS, while other
studies reported the opposite. Symptoms that were noted in a few patients
doing aerobic exercises were brief knee pain, chest pain, hip pain and
stress.
On average, more people who were exercising dropped
out of the studies compared to people who were not exercising: 25 out of 100
people who exercised dropped out while 12 out of 100 people who were not
exercising dropped out. Whether people dropped out because of difficulties
with exercise is not known.
What
did the scientists conclude about exercise for treating FMS?
Aerobic
exercises up to 20 weeks, such as cycling, walking or whole body or dance
aerobics that meet the ACSM guidelines, can result in better aerobic fitness,
less pain tenderness and overall well-being. It may or may not result in
less pain, better sleep and less fatigue. Anxiety and depression should
not be expected to improve with aerobic exercise of less than 20
weeks.
Strength exercises may result in
short term improvements in pain, muscle performance and mood but not in
fatigue or sleep.
Flexibility exercises and
combining different types of exercises may or may not be
beneficial. |
What
are some considerations about exercise?
| It is important to remember that regular aerobic
exercise can improve physical fitness and provide other health benefits even
when not specifically targeted to improving symptoms of FMS. Physical
activity, as opposed to an organized exercise programme, also provides benefits
and may be beneficial to people with FMS - more research is needed in this
area.
Most of the studies tested exercise over 6 to 20
weeks and therefore more studies need to be done to determine the effects of
exercise after 20 weeks.
More information about side effects or difficulties
with exercises is necessary to determine whether there are some people with FMS
who cannot tolerate exercise. |
From the Cochrane Systematic Review by Busch A,
Schachter CL, Peloso PM, Bombardier C. Exercise for treating fibromyalgia
syndrome (Cochrane Review). In: The Cochrane Library, Issue 4 2002. Oxford:
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