Group Exercise, Education, and Combination Self-management in Women With Fibromyalgia – Source: Archives of Internal Medicine, Nov 12, 2007

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Background: Self-management has increasingly been recommended as part of standard care for fibromyalgia, a common, poorly understood condition with limited treatment options. Data that assess popular self-management recommendations are scarce. We evaluated and compared the effectiveness of 4 common self-management treatments on function, symptoms, and self-efficacy in women with fibromyalgia.

Methods: A total of 207 women with confirmed Fibromyalgia were recruited from September 16, 2002, through November 30, 2004, and randomly assigned to 16 weeks of:

(1) Aerobic and flexibility exercise (AE);

(2) Strength training, aerobic, and flexibility exercise (ST);

(3) The Fibromyalgia Self-Help Course (FSHC); or

(4) A combination of ST and FSHC (ST-FSHC).

The primary outcome was change in physical function from baseline to completion of the intervention. Secondary outcomes included social and emotional function, symptoms, and self-efficacy.

Results:

  • Improvements in the mean Fibromyalgia Impact Questionnaire score in the 4 groups were –12.7 for the ST-FSHC group, –8.2 for the AE group, –6.6 for the ST group, and –0.3 for the FSHC group. The ST-FSHC group demonstrated greater improvement than the FSHC group (mean difference, –12.4; 95% confidence interval [CI], –23.1 to –1.7).

  • The ST-FSHC (mean difference, 13.6; 95% CI, 2.3 to 24.9) and AE (mean difference, 13.1; 95% CI, 1.6 to 25.6) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey.

  • Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC (14.8), AE (13.2), and ST (5.7) groups.

  • Social function, mental health, fatigue, depression, and self-efficacy also improved.

  • The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months.

  • Conclusions:

    Progressive walking, simple strength training movements, and stretching activities improve functional status, key symptoms, and self-efficacy in women with Fibromyalgia actively being treated with medication.

    The benefits of exercise are enhanced when combined with targeted self-management education.

    Our findings suggest that appropriate exercise and patient education be included in the treatment of Fibromyalgia.

    Trial Registration: clinicaltrials.gov Identifier: NCT00321659 http://www.clinicaltrials.gov/ct2/show/NCT00321659?term=NCT00321659&rank=1

    Source: Archives of Internal Medicine. November 12, 2007; 167(20):2192-2200. Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B, Goldenberg DL, Iversen MD, Katz Jan. Beth Israel Deaconess Medical Center; Newton Wellesley Hospital; Brigham and Women’s Hospital; Harvard Medical School, MGH Institute of Health Professions, Boston, Massachusetts, USA. [Dr. Rooks is now with the Norvartis Institutes for Biomedical Research in Cambridge, Massachusetts.]

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