Fibromyalgia Exercise Success

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Exercise is frequently recommended to individuals with Fibromyalgia as part of a comprehensive treatment plan in conjunction with medications, dietary supplements, educational programs, stress management techniques, and relaxation training. However, there appears to be a narrow window of opportunity for the Fibromyalgia patient, as too little exercise may not result in any noticeable benefit and too much may exacerbate the pain, stiffness, and fatigue associated with Fibromyalgia. Along those lines, individuals with Fibromyalgia face challenges when they initiate an exercise program, as it may temporarily increase symptoms of tenderness and pain as the body increases its level of conditioning and fitness. Therefore, physical fitness programs for Fibromyalgia patients should take into account individual fitness levels and conditioning, as well as pain sensitivity and fatigue levels. Ideally, exercise regimens should be tailored to the individual as there is no “one size fits all” approach. While the majority of research supports the use of low to moderate-intensity aerobic exercise and muscle strength training, other exercise modalities, such as Yoga and Nordic walking, may be preferable for – and of greater benefit to – some patients (depending on individual characteristics). Exercise should be introduced slowly and regularly, with careful monitoring by both patient and physician (or physical therapist).

 Literature Review

A comprehensive review by Busch et al. (2011) evaluated findings from recent randomized controlled trials (a study design regarded as the “gold standard” for research purposes) to determine factors that influence an individuals’ response to exercise and ability to stick with exercise regimens, in an effort to help doctors better determine which modes of physical activity and exercise are most beneficial to prescribe for patients with Fibromyalgia.

The first randomized controlled trial to demonstrate the benefits of exercise training as treatment for Fibromyalgia symptoms was published in 1988. Since that time, the number of studies has increased substantially, accompanied by considerable improvements in the quality of their design. Research has supported the use of aerobic exercise and muscle strength training via both land-based and aquatic (water-based) regimens. Recent systematic review articles by Busch et al., Rauser et al., and Cazzola et al. have shown that aerobic exercise helps to reduce pain, fatigue, and depression in individuals with Fibromyalgia, as well as improve quality of life and overall physical fitness. These research review studies also revealed that strength training was linked to vast improvements in overall well-being and physical functioning, and suggested that aquatic activities may be as beneficial as land-based activities.

In addition to the well-documented benefits of aerobic exercise and strength training, less mainstream modalities are also receiving research attention, including more holistic methods such as Yoga and Tai-Chi, Nordic walking, Pilates, and vibration therapy. “Holistic” refers to the mind-body interaction and encompasses physical, psychosocial, emotional, spiritual and individual behavioral elements. A randomized controlled trial by Wang and colleagues investigated the effectiveness of Tai-Chi sessions (twice per week for twelve weeks) in 66 patients with Fibromyalgia. The researchers found vast improvements in quality of life and health status beyond what is typically reported in the literature for conventional exercise and drug therapies.

Yoga has also been demonstrated in a number of studies to be effective at managing the pain and functional limitations associated with Fibromyalgia (Carson et al, 2010; Ide et al, 2008). Furthermore, a 2009 study by Altan et al. demonstrated short-term benefits in pain and Fibromyalgia related quality of life.

Newer, more alternative exercise therapies such as vibration therapy have also been investigated in individuals with Fibromyalgia. These studies have been shown to improve balance, quality of life, and overall health status in Fibromyalgia patients. These results should be interpreted with caution, however, as the study sample sizes were small and may not be generalizable to large numbers of Fibromyalgia patients due to specific characteristics of the study subjects (i.e., one study was conducted exclusively in post-menopausal women) (Sanudo, 2010; Gusi, 2010). Nordic walking is high-intensity outdoor walking that involves the use of poles and places increased demands on the upper body. Mannerkorpi et al. (2010) tested Nordic walking in women with Fibromyalgia and found that in addition to being well-tolerated among women with Fibromyalgia, it increased their overall level of physical fitness and decreased the impact of Fibromyalgia on their overall quality of life.

The link between exercise and improvement in cognitive limitations commonly associated with Fibromyalgia, including limitations in thinking ability, memory, and attention span (frequently referred to as “FibroFog”) has recently been investigated. Although existing studies have been limited in their power to detect direct associations, positive effects were demonstrated for some measures and therefore additional research is needed in order to fully investigate this potential association (Etnier et al., 2009). 

 

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References

1.        Busch AJ, Webber SC, Brachaniec M, Bidonde J, Bello-Haas VD, Danyliw AD, Overend TJ, Richards RS, Sawant A, Schachter CL. Exercise therapy for Fibromyalgia. Curr Pain Headache Rep. 2011;15(5):358-367.

2.        Busch AJ, Overend TJ, Schachter CL. Fibromyalgia treatment: the role of exercise and physical activity. Int J Clin Rheumtol. 2009;4:343–380.

3.        Kelley GA, Kelley KS, Hootman JM, Jones DL. Exercise and global well-being in community-dwelling adults with Fibromyalgia: a systematic review with meta-analysis. BMC Public Health. 2010;10:198.

4.        Hauser W, Klose P, Langhorst J, et al. Efficacy of different types of aerobic exercise in Fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther. 2010;12:R79.

5.        Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for Fibromyalgia. N Engl J Med. 2010;363:743–754.

6.        Carson JW, Carson KM, Jones KD, et al. A pilot randomized controlled trial of the Yoga of awareness program in the management of Fibromyalgia. Pain. 2010;151:530–539.

7.        Ide MR, Laurindo LMM, Rodrigues-Junior AL, Tanaka C. Effect of aquatic respiratory exercise-based program in patients with Fibromyalgia. Int J Rheum Dis. 2008;11:131–140.

8.        Altan L, Korkmaz N, Bingol U, Gunay B. Effect of Pilates training on people with Fibromyalgia syndrome: a pilot study. Arch Phys Med Rehabil. 2009;90:1983–1988.

9.        Mannerkorpi K, Nordeman L, Cider A, Jonsson G. Does moderate-to-high intensity Nordic walking improve functional capacity and pain in Fibromyalgia? A prospective randomized controlled trial. Arthritis Res Ther. 2010;12:R189.

10.  Etnier JL, Karper WB, Gapin JI, et al. Exercise, Fibromyalgia, and fibrofog: a pilot study. J Phys Act Health. 2009;6:239–246.

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