Swimming for Fibromyalgia

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Water based exercise including swimming has been demonstrated as particularly effective for patients with fibromyalgia. While research studies specifically focused on swimming alone are scarce, one 2004 abstract reported the findings of a study designed to measure the impact of winter swimming on general well-being. In the summary of results, the authors indicated that swimmers were more likely to have physician-diagnosed diseases, and that tension, fatigue, memory impairment, and negative mood all improved with the duration of swimming. The authors specifically mentioned that those swimmers who suffered from fibromyalgia, rheumatism, and asthma all indicated that swimming provided pain relief (Huttunen et al., 2004). A 2000 study involving 25 women and 2 men with fibromyalgia allowed participants to participate in their choice of 12 weeks of jogging, walking, cycling, or swimming in accordance with a pre-determined training schedule. Twelve sedentary fibromyalgia patients (11 females, one male) served as a control group. While the study found general overall improvements in fitness level and well-being among those in the exercise group, no specific results were reported for those who chose swimming as their exercise modality (Meiworm et al., 2000). Despite the lack of research specifically pertaining to swimming, several review articles have independently analyzed and confirmed individual study findings that provide strong evidence for the use of water-based exercise as a therapeutic modality in fibromyalgia (McVeigh et al., 2008; Gowans & deHueck, 2007). It has been shown to result in improvements to pain, range of motion, sleep quality, anxiety and depression, cognitive functioning, and overall health status.

Building on their earlier findings that suggested a positive impact of pool-based exercise and education on fibromyalgia symptoms (Mannerkorpi et al., 2000), Mannerkorpi and colleagues  randomly assigned 134 women with fibromyalgia and 32 women with chronic widespread pain to one of two exercise interventions: 1) 20-session pool-based exercise plus a six-session educational program, or 2) a control group consisting of only the educational program. The goals of the study were to determine the impact of the pool-based exercise and an educational program on fibromyalgia pain, health status, functioning, fatigue, depression, health-related quality of life, and amount of time spent in leisure activities among women with fibromyalgia or chronic widespread pain. The education program was structured to teach coping strategies for fibromyalgia symptoms, and consisted of six, one-hour sessions once each week for a period of six weeks. Discussion and practical exercises were utilized to cover topics such as long-lasting pain, pain alleviation, physical activity, stress, relaxation, and lifestyle modifications. The educational program structure and delivery was identical for both the control group and those randomized to also receive the pool-based therapy. The pool-based therapy consisted of 20 supervised exercise session, each 45 minutes in duration, in a warm-water pool. Exercises were designed to foster individual progress and improve overall functioning, as well as to motivate participants to perform regular physical activity. Both aerobic exercise and flexibility/stretching exercises were performed.

As measured by the Fibromyalgia Impact Questionnaire (FIQ; a validated 20-item questionnaire designed to measure the impact that fibromyalgia has on a patient’s ability to perform daily activities, their overall well-being, and their symptoms), those who participated in both the pool-based exercise and educational program demonstrated significantly higher improvements in overall fibromyalgia impact. In addition, those in the exercise-education group showed greater reductions in pain, health status, as well as incremental improvements in various measures of fatigue The authors noted that an increased frequency of pool-based exercise may lead to more profound and longer-lasting benefits (as this study only lasted for 20 weeks and participants in the exercise group only had one exercise session per week). In addition, because the control group received an educational intervention which itself is a form of treatment, it may have minimized the effect that the pool-based therapy had on the outcomes of interest. Nevertheless, this study demonstrated that pool-based therapy can be an effective tool for improving the health status of fibromyalgia patients and those with non-specific, chronic widespread pain (Mannerkorpi et al., 2009). Prior research my Mannerkorpi and colleagues has also demonstrated that symptom improvements due to pool-based exercises (including fibromyalgia impact, pain, fatigue, walking ability, and social ability) were evident at six and 24 months following completion of the study-based exercise intervention (Mannerkorpi et al., 2002).

Another randomized-controlled study (the “gold standard” for research study design) used a 16-week water-based exercise program that incorporated elements of strength training, aerobic exercise, and relaxation training. Exercise sessions occurred three times a week for approximately one hour. Those in the control group were instructed not to change their physical activity habits for the duration of the study. In total, 60 women with fibromyalgia and 25 healthy controls participated in the study (35 fibromyalgia patients in exercise group, 25 fibromyalgia patients in control group, and 25 healthy subjects for comparison). The study examined the impact of the exercise therapy on participants’ pain, health status, anxiety, sleep quality, and cognitive function. Following conclusion of the study and analysis of the data, the researchers found that those in the exercise group experienced significant improvements in their numbers of tender points, sleep quality, physical strength and endurance, cognitive function, and overall fibromyalgia impact (as measured by the FIQ). Despite their encouraging findings, the authors note the small sample size of their study and indicate that additional research in larger populations is required to validate their findings (Munguir-Izquierdo & Legaz-Arrese, 2008).

Benefits and Challenges

The non-impact nature of water-based exercise, particularly swimming, can be of great benefit to fibromyalgia patients, and the buoyancy of water facilitates easy movement. Water can also have a calming effect on the body and promote relaxation, as well as decreasing pain perception. If possible, warm water pools are preferable over cooler water pools, as cold can result in unnecessary muscle tension. Therapeutic warm water pools can be located using the locator software on the following website:  www.findapool.com

A potential challenge for those interested in water-based therapy as part of their fibromyalgia treatment plan may be accessibility, especially if they live in an area where there are no aquatic facilities. Individuals who do not know how to swim also face obvious obstacles in pursuing water-based exercise. Finally, costs associated with pool or health club membership may preclude others from gaining access by virtue of economic factors.

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References

1.        McVeigh JG, McGaughey H, Hall M, Kane P. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatol Int. 2008;29(2):119-130.

2.        Gowans SE, deHueck A. Pool exercise for individuals with fibromyalgia. Curr Opin Rheumatol. 2007;19(2):168-173.

3.        Huttunen P, Kokko L, Ylijukuri V. Winter swimming improves general well-being. Int J Circumpolar Health. 2004;63(2):140-144.

4.        Meiworm L, Jakob E, Walker UA, Peter HH, Keul J. Patients with fibromyalgia benefit from aerobic endurance exercise. Clin Rheumatol. 2000;19(4):253-257.

5.        Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol. 27(10):2473-2481.

6.        Mannerkorpi K, Nordeman L, Ericsson A, Arndorw M, GAU Study Group. Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses. J Rehabil Med. 2009;41:751-760.

7.        Mannerkorpi K, Ahlmen M, Ekdahl C. Six- and 24-month follow-up of poll exercise therapy and education for patients with fibromyalgia. Scand J Rheumatol. 2002;31(5):306-310.

8.        Munguia-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomotology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(12):2250-2257.

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