Exercise Impact on Tender Points


This article is focused on research studies conducted to determine the effects of different types of exercise (aerobic, strength training or both) on chronic widespread pain and Fibromyalgia tenderness using Tender Point (TP) scores in adults with Fibromyalgia. The management of Fibromyalgia can be, as you know, difficult to manage and for many include both pharmacologic and non-pharmacologic approaches. Exercise is a very simple, low-cost form of treatment that is readily available to most people with Fibromyalgia.

Many studies have been conducted over the years related to effective treatments for Fibromyalgia patients. Since this syndrome has no known single definitive cause, it is difficult to predict how each individual will respond to various types of treatment. However, exercise has been widely covered as a simple and effective option.  One study by George Kelly, Kristi Kelly and Dina Jones(Efficacy and Effectiveness of Exercise on Tender Points in Adults with Fibromyalgia: A Meta-Analysis of Randomized Control Trails, 2011), was designed to use a database analysis of several separate, but similar studies. They analyzed the information within these studies and the results of each were combined to see if there was a significant change in widespread pain and tenderness following exercise intervention trials.

Past research (prior to 2005) concluded that moderate intensity aerobic exercise had little to no effect on tender point scores, but strength training could dramatically reduce tender point scores. Additional studies, beyond 2005, lead to conflicting results, inaccurate analysis of data and difficulties associated with large data analyses needing to be updated on a regular basis (which was not the case). Kelly, et al, through a large database analysis approach, reviewed 1,024 studies and narrowed this report down to nine studies. 

These nine studies included 19 groups (10 exercise and 9 control) with 362 participants (200 exercise and 162 control).  The participants in these groups were predominantly female, between 37 and 60 years of age. Eleven of the groups reported that their members took some type of prescribed drug for Fibromyalgia before and during the study. Eleven groups reported being sedentary prior to participating in the studies, and 12 groups reported that one or more group members were overweight or obese.

The 19 participating groups had been divided into exercise and control groups. Of the exercise groups, five groups participated in aerobic exercise, three in strength training and two participated in both. Only eight of the groups reported data and of those reporting, six stated that exercise sessions were supervised, while two were unsupervised. The duration of training ranged from five to 40 minutes per session and lasted for 12 to 23 weeks in length. These studies overall did show that a statistically significant reduction in tender point scores was found (equivalent to 10.9%).

As stated previously, the main purpose of this study was to determine if exercise does have an effect on tender point scores in adults with Fibromyalgia. This review of previous studies concluded that exercise is a potentially important treatment option for those that comply with the prescribe intervention. However, the authors were unable to determine if the observed reduction in tender point score of 11% is particularly important and stated that other non-pharmacologic and/or pharmacologic may be necessary. Regardless of the type, for most individuals, exercise should be added to the normal treatment plan for adults with Fibromyalgia.

The authors did recommend several things for future studies. They stated that these studies should have a unique identifier (such as a number) to determine whether outcomes were reported, and are complete. Further studies need to include more about the study subjects prior to research. This screening information should include number of years since diagnosis, current diet (including alcohol) and all treatment. Treatment should include all current non-pharmacologic and pharmacologic therapies, as well as all previously attempted therapies that did not work. This should include details such as type of exercise (including any equipment used and location/setting), length, frequency, intensity and duration, as well as compliance to exercise protocol. It was also recommended that more men be included in future exercise intervention studies. This may be more difficult since the majority of adults diagnosed with Fibromyalgia are female.

This database analysis did conclude with the suggestion that previous study information shows that exercise is effective for reducing tender point scores in selected females with Fibromyalgia. These findings are important, because they provide medical practitioners and patients with an opportunity to use a research-based treatment that has been identified to decrease widespread pain and tenderness in women. One key factor is that these women must follow a regimen that works best for them and that they exercise on a regular basis.  

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