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Exercise Helps In Fibromyalgia Despite Initial Pain

  [ 157 votes ]   [ Discuss This Article ] • August 2, 2002

By Harvey McConnell

A series of controlled graded aerobic exercise is a simple, cheap, and effective treatment for patients with fibromyalgia.

A major problem at the beginning of an exercise program is convincing patients it will work because they suffer initial increases in pain and stiffness immediately after exercise. This may convince many patients at the beginning that exercise will worsen their condition, warns Dr Selwyn Richards and colleagues at the Department of Rheumatology at Poole Hospital, Poole, Dorset, England.

Conventional medical treatment of fibromyalgia with analgesics, non-steroidal anti-inflammatory drugs, and antidepressants is relatively ineffective, the clinicians said. Several randomized controlled trials of exercise therapy in fibromyalgia produced generally positive results, but were under-powered, excluded many cases, and were supervised in hospitals by highly experienced healthcare professionals.

One hundred and thirty two men and women with fibromyalgia, selected from an initial population of 7,806 patients attending the hospital rheumatology clinic, were enrolled over a one year period into a randomized controlled trial. The patients were randomly assigned to either aerobic exercise classes or relaxation classes, twice weekly for 12 weeks. Classes were carried out by personal trainers with no special experience in providing exercise for people with ill health.

The clinicians then gauged results based on the men and women who reported on their improvement, plus tender point count, impact of condition measured by fibromyalgia impact questionnaire, and short form McGill pain questionnaire.

The exercise program, when compared with the relaxation program, led to significantly more men and women rating themselves as much, or very much, better at three months. These benefits were maintained, or even improved in some patients, when they were assessed a year later, especially the fall in tender point counts.

The researchers said exercise treatment has limitations, especially with compliance by the men and women when they suffer pain after beginning the exercise program. "Future strategies to increase the efficacy of exercise as an intervention should confront the issue of compliance," they conclude.

Source: BMJ 2002; 325:185-187. © 2002 British Medical Journal (BMJ).


Objectives: To evaluate cardiovascular fitness exercise in people with fibromyalgia.

Design: Randomised controlled trial.

Setting: Hospital rheumatology outpatients. Group based classes took place at a "healthy living centre."

Participants: 132 patients with fibromyalgia.

Interventions: Prescribed graded aerobic exercise (active treatment) and relaxation and flexibility (control treatment).

Main outcome measures: Participants' self assessment of improvement, tender point count, impact of condition measured by fibromyalgia impact questionnaire, and short form McGill pain questionnaire.

Results: Compared with relaxation, exercise led to significantly more participants rating themselves as much or very much better at three months: 24/69 (35%) v 12/67 (18%), P=0.03. Benefits were maintained or improved at one year follow up when fewer participants in the exercise group fulfilled the criteria for fibromyalgia (31/69 v 44/67, P=0.01). People in the exercise group also had greater reductions in tender point counts (4.2 v 2.0, P=0.02) and in scores on the fibromyalgia impact questionnaire (4.0 v 0.6, P=0.07).

Conclusions: Prescribed graded aerobic exercise is a simple, cheap, effective, and potentially widely available treatment for fibromyalgia.

Source: BMJ 2002;325:185

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