Exercise and Education a Boost to Women With Fibromyalgia
BOSTON, Nov. 13 -- Fibromyalgia functional symptoms and pain respond to a program of walking, strength training, and stretching, according to researchers here.
Action Points
Explain to patients who ask that for women with fibromyalgia who take medication, an exercise program of walking, strength training, and stretching, plus learning self-management skills, improved function and pain symptoms.
In addition, the benefits appeared to be enhanced when a self-management education program was added, Daniel S. Rooks, Sc.D., of Harvard, and colleagues, reported in the Nov. 12 issue of the Archives of Internal Medicine.
A randomized trial found a statistically significant improvement of 25% among women assigned to an exercise program plus a self-help course, compared with no benefit for those given only the self-help course, said Dr. Rooks, now with Novartis Institutes for Biomedical Research in Cambridge, Mass., and colleagues.
This study suggested that progressive walking, simple strength training movements, and stretching activities can improve physical, emotional, and social function, key symptoms, and self-efficacy in women with fibromyalgia being actively treated with medication, the researchers wrote.
The benefits of exercise, when combined with targeted self-management education, continued for six months after completion of the intervention, the researchers said.
Fibromyalgia affects approximately 3.4% of women and 0.5% of men in the U.S., according to the researchers. But even with the 2004 FDA approval of pregabalin (Lyrica), drug therapy is often insufficient to resolve persistent symptoms or improve functional limitations and quality of life, they wrote.
To compare the effectiveness of four common self-management treatments on function, symptoms, and self efficacy, the researchers recruited 207 women from 2002 through 2004, all taking medication. They were randomly assigned to one of four groups for 16 weeks. A total of 135 women completed the study.
The groups included aerobic and flexibility exercise; strength training added to aerobic and flexibility exercise (three-part workout); the Arthritis Foundation's Fibromyalgia Self-Help Course; or a combination of the three-part exercise program plus the self-help course.
The exercise groups met twice weekly, gradually increasing the length and intensity of workouts, with instructions to perform a third day of exercise on their own.
The seven-session self-management education program provided information about fibromyalgia, taught self-management skills in daily activities, and suggested ways to manage symptoms and incorporate wellness activities, including exercise, into daily life. Information was provided through lectures (five to 15 minutes) with group discussion and supplementary readings.
All exercise programs lasted about 60 minutes beginning with a brief warm-up walking on a treadmill and then progressing to a self-determined level of moderate effort for a predetermined amount of time.
As measured by two self-assessment questionnaires and a performance test (the Fibromylagia Impact Questionnaire score), all exercise groups showed greater improvement in function compared with the education group, the researchers reported.
In the four groups, the improvements in the mean Fibromyalgia Impact score were:
−12.7 for the strength, aerobic, and flexibility (full exercise) group plus the education program
−8.2 for the aerobic and flexibility group alone (no strength training)
−6.6 for the three-part exercise group alone (these women divided their time between aerobic exercise, flexibility, and strength training)
−0.3 for the education group alone
Examination of the Fibromyalgia Impact total score total showed that women in the full exercise plus education group demonstrated a 25% greater improvement than the education-alone group (mean difference, −12.4, 95% confidence interval: −23.1 to −1.7).
Bodily pain scores on the 36-Item Short-Form Health Survey improved in the three-part exercise plus education group (14.8), the aerobic/flexibility group (13.2), and in the three-part exercise group (5.7).
Social function, mental health, fatigue, depression, and self-efficacy also improved in the groups that exercised.
Among the study's limitations was the fact that the study was designed not to have a group that received no intervention to minimize bias of interpersonal contact with persons in active interventions. Therefore, it was not possible to determine how an intervention group compared with no treatment.
Also about one-third of the overall sample dropped out, a rate similar to previous fibromyalgia studies that used comparable interventions.
This research was supported by an Arthritis Foundation Investigator Award and National Institutes of Health grants.
The investigators reported no financial conflicts.Primary source: Archives of Internal MedicineSource reference: Rooks, DS, et al "Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial"Arch Intern Med 2007; 167: 2192-2200.