Fibromyaliga and exercise-Rheumatology International, 2007

Rheumatology International,  November 3, 2007

Effects of muscle strengthening versus aerobic exercise program in fibromyalgia– Ç. Bircan, S. A. Karasel, B. Akgün, Ö. El · S. Alper

KEY POINTS

1) “Fibromyalgia is a chronic painful condition characterized by widespread pain, pain at specific tender points, sleep disturbance, and fatigue.”

2) Fibromyalgia is more common in females than males.

3) “The majority of patients with Fibromyalgia are known to be aerobically unfit and have poor muscle strength and limited flexibility.”

4) “It is widely accepted that exercise is beneficial for patients with fibromyalgia.”

5) The aerobic exercise  program comprised walking on treadmill, initially for 20 min and increasing up to 30 min as the patient tolerated. Exercise intensity was adjusted to generate heart rates equivalent to 60–70% of age-adjusted maximum heart rates (220 minus age in years).

6) Patients in the strengthening exercise group received a supervised, progressive physical training program, with muscle strengthening of the upper and lower limb muscles and trunk muscles, initially with 4–5 repetitions and progressing to 12 repetitions gradually.  Patients began with resistance levels they could do easily, and weight was increased gradually according to patient’s tolerance.

7) Outcome measures were the intensity of fibromyalgia-related symptoms (pain, fatigue, sleep disturbance), tender point count, cardiovascular fitness, psychological status, and quality of life.

8 ) Pain intensity was measured with visual analog scale (VAS).

9) “Cardiovascular fitness was assessed by 6-min walk test, which is a reliable and valid measure in fibromyalgia patients.”

10) The SF-36 was used to evaluate quality of life. The SF-36 is a generic measure of quality of life addressing eight health concepts: physical functioning, role physical, bodily pain, vitality, role emotional, social functioning, mental health, and general health. Scores for each dimension range from 0 (poor health) to 100 (good health).

11) In this study, pain, sleep, fatigue, tender point counts, 6-min walk distances, depression, and quality of life improved to a similar degree after strengthening and aerobic exercise in patients with fibromyalgia syndrome.

12) [IMPORTANT] No patient experienced musculoskeletal injury or exacerbation of fibromyalgia-related symptoms during the intervention.

13) The magnitude of change was generally greater in the strengthening group v. the aerobic group.

14) “Muscle strengthening may be more important than aerobic training in improving fitness in fibromyalgia patients.”

15) “In healthy individuals and individuals with psychiatric disease, exercise is known to improve depression and anxiety.”

16) “Both aerobic exercise and resistance training have been shown to reduce depressive symptoms.”

17) “In conclusion, aerobic exercise and strengthening exercise were similarly effective at improving symptoms, tender point count, fitness, psychological status, and quality of life in fibromyalgia patients.”

Other good articles to check out:

1. Journal of Nutritional Medicine-No. 3, 1992 pp. 49-59-Management of Fibromyalgia:  Rationale for the use of Magnesium and Malic Acid
Guy E. Abraham M.D. and Jorge D. Flechas, M.D. M.P.H.
https://adjust2it.wordpress.com/category/magnesium-and-malic-acid-rational-for-fibromylgia/

2.  Curr Opin Rheumatol 2004 16:157–163-Staud R -Fibromyalgia pain: do we know the source?

3. Journal of the American Medical Assoc. 2004;292:2388-2395-Goldenberg DL, Burckhardt C, CroVord L-Management of fibromyalgia syndrome.

Back to orginal study below-Effects of muscle strengthening versus aerobic exercise program in fibromyalgia

FROM ABSTRACT
The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia. Thirty women with fibromyalgia were randomized to either an aerobic exercise (AE) program or a strengthening exercise (SE) program for 8 weeks.

Outcome measures included the intensity of fibromyalgia-related symptoms, tender point count, fitness (6-min walk distance), hospital anxiety and depression (HAD) scale, and short-form health survey (SF-36).

There were significant improvements in both groups regarding pain, sleep, fatigue, tender point count, and fitness after treatment.  HAD-depression scores improved significantly in both groups while no significant change occurred in HAD anxiety scores.

Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group, whereas seven subscales of SF-36, physical component summary, and mental component summary improved significantly in the SE group.

When the groups were compared after treatment, there were no significant differences in pain, sleep, fatigue, tender point count, fitness, HAD scores, and SF-36 scores. AE and SE are similarly effective at improving symptoms, tender point count, fitness, depression, and quality of life in fibromyalgia.

THESE AUTHORS ALSO NOTE:
“Fibromyalgia is a chronic painful condition characterized by widespread pain, pain at specific tender points, sleep disturbance, and fatigue.”  Fibromyalgia is more common in females than males.

The symptoms of fibromyalgia are often caused by altered peripheral nociceptive mechanisms and central pain processing.  [wind-up, central sensitization]

“It is widely accepted that exercise is beneficial for patients with fibromyalgia.” & “The majority of patients with FM are known to be aerobically unfit and have poor muscle strength and limited flexibility.” [mechanical stimulation…mechanoreception from muscle spindles]

Subjects in both groups exercised three times per week for 8 weeks.

The aerobic exercise program comprised walking on treadmill, initially for 20 min and increasing up to 30 min per patient tolerance. Exercise intensity was adjusted to generate heart rates equivalent to 60–70% of age-adjusted maximum heart rates (220 minus age in years).

Patients in the SE group received a supervised, progressive physical training program, with muscle strengthening of the upper and lower limb muscles and trunk muscles, initially with 4–5 repetitions and progressing to 12 repetitions gradually.

Patients began with resistance levels they could do easily, and weight was increased gradually according to patient’s tolerance.

Outcome measures were the intensity of fibromyalgia-related symptoms (pain, fatigue, sleep disturbance), tender point count, cardiovascular fitness, psychological status, and quality of life.

Pain intensity was measured with visual analog scale (VAS).

“Cardiovascular fitness was assessed by 6-min walk test, which is a reliable and valid measure in fibromyalgia patients.” Subjects were instructed to walk as far as they could at a fast, comfortable pace in 6 min. The distance walked in 6 min was recorded.

The SF-36 was used to evaluate quality of life. The SF-36 is a generic measure of quality of life addressing eight health concepts: physical functioning, role physical, bodily pain, vitality, role emotional, social functioning, mental health, and general health. Scores for each dimension range from 0 (poor health) to 100 (good health).

None of the patients had a habit of regular physical activity before participating in the study.

There were similar significant improvements in both groups regarding pain, sleep, fatigue, tender point count, and 6-min walk distance after treatment. HAD scale-depression scores improved significantly in both groups as well.

DISCUSSION

“Our study demonstrated that pain, sleep, fatigue, tender point counts, 6-min walk distances, depression, and quality of life improved to a similar degree after SE and AE in patients with fibromyalgia syndrome.”

“No patient experienced musculoskeletal injury or exacerbation of fibromyalgia-related symptoms during the intervention.”

The magnitude of change was generally greater in the strengthening group v. the aerobic group in other similar investigations.

In this study, there was significant improvements in fibromyalgia symptoms and tender point counts in both groups. [IMPORTANT]

“Six-minute walk distance increased 41 m in the AE group and 77 m in the SE group.”

In this study, the improvement in 6-min walk distance was greater in the SE group than the AE group. “This finding suggests that muscle strengthening may be more important than aerobic training in improving fitness in fibromyalgia patients.”

“In healthy individuals and individuals with psychiatric disease, exercise is known to improve depression and anxiety.”

“Both AE and resistance training have been shown to reduce depressive symptoms.”

“In conclusion, aerobic exercise and strengthening exercise were similarly effective at improving symptoms, tender point count, fitness, psychological status, and quality of life in fibromyalgia patients.”

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