Appropriate Exercise, Patient Education May Be Helpful for Fibromyalgia

November 19, 2007 — Progressive walking, simple strength training, and stretching improved functional status, key symptoms, and self-efficacy in women with fibromyalgia actively treated with medication, according to the results of a randomized controlled trial reported in the November 12 issue of the Archives of Internal Medicine.
"Self-management has increasingly been recommended as part of standard care for fibromyalgia, a common, poorly understood condition with limited treatment options," write Daniel S. Rooks, ScD, from the Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues. "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."
From September 16, 2002, through November 30, 2004, a total of 207 women with confirmed fibromyalgia were recruited and randomized to receive 16 weeks of aerobic and flexibility exercise (AE); strength training, aerobic, and flexibility exercise (ST); the Fibromyalgia Self-Help Course (FSHC); or a combination of ST and FSHC (ST-FSHC). The main endpoint was change in physical function from baseline to completion of the 16-week intervention; secondary endpoints were social and emotional function, symptoms, and self-efficacy.
The mean Fibromyalgia Impact Questionnaire score improved by −12.7 in the ST-FSHC group, −8.2 in the AE group, −6.6 in the ST group, and −0.3 in the FSHC group. Compared with the FSHC group, the ST-FSHC group had greater improvement (mean difference, −12.4; 95% confidence interval [CI], −23.1 to −1.7).
Physical function scores on the 36-Item Short-Form Health Survey improved to a similar extent in the ST-FSHC (mean difference, 13.6; 95% CI, 2.3 - 24.9) and AE groups (mean difference, 13.1; 95% CI, 1.6 - 25.6). On the 36-Item Short-Form Health Survey, bodily pain scores improved in the ST-FSHC (14.8), AE (13.2), and ST (5.7) groups, as did social function, mental health, fatigue, depression, and self-efficacy. Benefits on physical function of exercise alone and combined with education were maintained at 6 months.
"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 study authors write. "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."
Limitations of the study include absence of a control group that received no intervention and dropout of approximately one third of the overall sample.
"The findings of this study contribute to the growing body of knowledge on the benefits of exercise and physical activity for improving the health and function of adults with chronic illness," the study authors conclude. "People with rheumatic conditions are even less active than the relatively sedentary general public. Future studies are needed to identify ways of integrating appropriate exercise into the treatment plans of people with fibromyalgia and other chronic illnesses and to promote the adoption and maintenance of a more physically active lifestyle."
The Arthritis Foundation and National Institutes of Health supported this study. Dr. Rooks is now employed by the Novartis Institutes for Biomedical Research, Inc, Cambridge, Massachusetts. Four of the study authors have received funding from the Arthritis Foundation and National Institutes of Health. The remaining study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2007;167:2192-2200