Background Exercise has been identified as the most effective intervention in the management of Fibromyalgia (FM), however, patients often report difficulty in initiating and maintaining a regular exercise programme.^1,2 In 1996 a FM programme was developed at our hospital. Patients attend for 6 weeks and follow a progressive exercise programme of land-based exercise and hydrotherapy. The initial emphasis is on conditioning and stretching as preparation for increased activity. Patients are then encouraged to develop their own home exercise/activity programme, which they should continue on completion of our programme.

Method 50 consecutive patients with FM were diagnosed by Consultant Rheumatologist using the ACR criteria for FM.³ Female patients 39 (78%), male patients 11 (22%), age range 28–78 (mean 51.8 years). Symptom duration was as follows; <1 Year 11.1%; 1–5 Years 50.0%; 6–10 Years 16.7%; > 10 Years 5.5%; Patient Unsure 16.7%. Time since diagnosis was as follows; Less Than 1 Year 55.6%; 1–5 Years 38.9%; 6–10 Years 5.5%. Patients completed a series of validated questionnaires prior to participation on the programme and again at 6 weeks. The Nottingham Health Profile, Health Assessment Questionnaire and Hospital Anxiety Depression Scale were used thus assessing the major areas affected by FM – quality of life, mood, function and pain.

Results A third of patients reported improvements in mood and in some measures of global health specifically Physical Function and Social interaction. Generally pain did not significantly improve. However it should be remembered that this programme is designed as an initiation to exercise. Much of the work previously reported regarding the benefits of exercise entailed aerobic exercise with most studies having high drop out rates.^4,5 Our programme introduced patients to gentle levels of exercise and progressed to more intensive work. The limitations of a 6-week programme mean we cannot progress to the aerobic levels where it has been demonstrated that pain and fatigue levels can be altered. The next stage of our project is to develop a community-based exercise programme. This combined approach of a gentle initiation followed by long-term exercise will be assessed at 6 and 12 months.

Conclusion We believe that this collaboration is innovative and has great potential in offering significant health improvements to Fibromyalgia patients.

References

1. Waylonis MD, Perkin RH. Post-traumatic fibromyalgia – a long-term follow- up. Am J Phys Med. 1996;73:404–12

2. Horven Wigers S, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in Fibromyalgia. A 4–5 year prospective study. Scand J Rheumatol. 1996;25:77–86

3. Wolfe F, Smythe HA, Yunus MB. The American College of Rheumatology 1990 criteria for the classification of Fibromyalgia. Report of the Multi-centre Criteria Committee. Arthritis Rheum. 1990;33:160–72

4. Martin L, Nutting A, Mcintosh BR, Edworthy SW, Butterwick D. An exercise programme in the treatment of Fibromyalgia. J Rheumatol. 1994;23(6):1050–3