Exercise as it relates to Disease/Exercise as a treatment option for Fibromyalgia

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Background[edit]

What is Fibromyalgia?[edit]

Fibromyalgia (FM) is a chronic illness and is defined as having widespread pain to all four quadrants of the body for more than three months[1] [2]. FM patients, when examined by a GP will also have recognized pain in at least 11 of the 18 specified tender points [3][4] [2]. The etiology of FM is not fully understood but altered peripheral nociceptive mechanisms and central pain processing are considered to be the main reasons behind the illness [5]. Across all ages, the prevalence of FM has been reported to be 1-2% [3][6].

Symptoms of FM[edit]

Individual’s suffering from FM may also experience a range of other symptoms that can impact on their daily lives. These symptoms include [1] [2] [7] :

  • Sleep difficulties
  • Fatigue
  • Stiffness / muscle cramps
  • Irritable bowel syndrome
  • Headaches/migraines
  • Cognitive dysfunction
  • Psychological distress

Exercise and FM[edit]

Exercise as a treatment option[edit]

Exercise is often an under reported form of treatment for individuals suffering FM. Exercise has been reported to relieve symptoms and improve the overall quality of life in FM sufferers [5]. Many individuals with FM tend to be sedentary and therefore display below average levels of aerobic capacity, strength and flexibility [1][5]. Individuals are physically able to participate in exercise but they often avoid it [1]. Some common reasons for avoiding exercise are:

  • Symptoms associated with FM (listed above) inhibit exercise [1]
  • Increased pain associated with micro-tears of the muscle [1] [7] [6]
  • A lack of perceived benefits associated with exercise [6]
  • Fear of worsening symptoms [6][8]

Recommendations[edit]

Current recommendations state that aerobic exercise is the most effective form of treatment for FM [1] [7][6] [8]. Aerobic programs need to include graded fitness exercises [7] [6] [8] while intensity should be increased slowly [1]. If an individual experiences any increase in their symptoms, the volume of exercise should be decreased until symptoms are reduced [1]. Low to moderate exercise is most beneficial and can include sessions such as:

  • Walking for 20 to 30 minutes, 2-3 times a week [1] [5] [7] [9] with a heart rate (HR) between 60-70% of max HR [7].
  • Walking 2 x 10 minute sessions once a day [5]
  • Low impact cycling [7][9]
  • Modified low impact aerobic dance [7][9]
  • Warm water pool aerobics [9][10]

Programs focusing exclusively on strength have also shown to provide some relief in symptoms [1][5]. However, due to limited research it is unclear which exercises, volumes and intensities are best for FM sufferers [5][9].

Benefits[edit]

The most commonly acknowledged benefit of an exercise program in the treatment of FM, is the improvement in psychological well-being and subsequent quality of life [5][7] [8]. General benefits associated with exercise include:

Aerobic only exercise Strength only exercise
Psychological benefits [7][10] Physical benefits [7][6][10] Psychological & physical benefits [1] [5][11]
  • Increased self efficacy
  • Decreased feelings of helplessness
  • Decreased depression
  • Decreased anxiety
  • Increased physical function
  • Increased aerobic capacity
  • Decreased muscle tension
  • Decreased fatigue
  • Decreased number of tender points/ overall pain
  • Reduced sensitivity at specified tender points
  • Decreased depression
  • Increased aerobic capacity
  • Increased quality of sleep
  • Decreased fatigue
  • Decreased number of tender points/ overall pain

Considerations[edit]

For optimum relief an aerobic exercise program needs to be completed on a regular basis. An inconsistent schedule of exercise does not allow the body to develop resilience to initial pain [1][7]. Trainers and instructors should also be aware that dropout rates are high [6][9] because many people with FM have difficulty sticking to an exercise program [1].

Other treatments[edit]

Other treatment options for FM include education [8], cognitive behavioral therapy (CBT) or pharmacotherapy [5].

Recommended Further Research[edit]

  • There is currently limited research into the relationship between strength only exercise and the benefits for FM [1][5]
  • There are currently no studies looking into the effects of flexibility as a form of FM treatment [1]
  • There needs to be further study conducted regarding possible treatment options e.g. aerobic versus strength only, strength only versus flexibility and combinations of these treatments [1][7]
  • Studies need to assess the effect of varied exercise intensities [7] and environments [1] e.g. aquatic versus terrestrial
  • High drop out rates need addressing [6]
  • Exploring other treatment options e.g. psychological in combination with exercise.

List of Recommended Readings[edit]

  1. Mayo Clinic - Fibromyalgia by the Mayo Foundation for Medical Education and Research
  2. Fibromyalgia Professional Resource Center from the National Fibromyalgia Association
  3. Questions and Answers about Fibromyalgia by NIH

References[edit]

  1. a b c d e f g h i j k l m n o p q r Busch A, Barber K, Overend T, Peloso P, Schachter C. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev 2007;4(4).
  2. a b c Fibromyalgia Network [Internet]. Tucson: Fibromyalgia Netwrok; c1988 [cited 2013 Oct 21]. Available from http://www.fmnetnews.com
  3. a b Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis & Rheumatism 1995;38(1):19-28.
  4. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism 1990;33(2):160-172.
  5. a b c d e f g h i j k Bircan Ç, Karasel SA, Akgün B, El Ö, Alper S. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatol Int 2008;28(6):527-532.
  6. a b c d e f g h i Richards SC, Scott DL. Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. BMJ: British Medical Journal 2002;325(7357):185.
  7. a b c d e f g h i j k l m n Meyer BB, Lemley KJ. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. Med Sci Sports Exerc 2000;32(10):1691-1697.
  8. a b c d e Ramsay C, Moreland J, Ho M, Joyce S, Walker S, Pullar T. An observer‐blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Rheumatology 2000;39(5):501-505.
  9. a b c d e f Mannerkorpi K, Iversen MD. Physical exercise in fibromyalgia and related syndromes. Best Practice & Research Clinical Rheumatology 2003;17(4):629-647.
  10. a b c Saltskår Jentoft E, Grimstvedt Kvalvik A, Marit Mengshoel A. Effects of pool‐based and land‐based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis Care & Research 2001;45(1):42-47.
  11. Brosse AL, Sheets ES, Lett HS, Blumenthal JA. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Medicine 2002;32(12):741-760.