Background Fibromyalgia (FM) is characterized by persistent widespread pain and increased pain sensitivity. Muscle strength is decreased by 20-50% in FM. Patients with FM describe difficulties to perform work and exercise due to activity-induced pain. Cochrane review group emphasizes the need of high quality studies with larger samples (1).
Objectives The aim of this randomized controlled trial (RCT) is to investigate the effects of progressive resistance exercise on physical function, health status and pain in women with FM. The exercise was planned together with each patient according to person-centered principles and adjusted to individual resources, limitations and preferences. Progressive relaxation was chosen as active comparator. Clinicaltrials.gov NCTO1226784.
Methods Study design: Women 20-65 years, fulfilling ACR 1990 criteria (2) for FM were recruited. We hypothesized that progressive resistance exercise improves physical function, health status and pain in FM. Physical function was assessed by 6-minute walk test (6MWT), and by measurement of quadriceps and biceps muscle strength by dynamometers (StigStarke, Isobex). Health status was assessed by Fibromyalgia Impact Questionnaire (FIQ) total score (0-100) (3). Current pain was rated on 0-100 mm VAS. We also analyzed self-efficacy for exercise (ESES).
Intervention: The supervised standardized interventions were conducted twice a week for 15 weeks at three sites. Exercise was started at 40% of maximum capacity, increased to 60% and to 80% for those who managed it.
Patients: The study population comprised 130 women with FM, mean age being 51 (SD 9.4) years. Their mean symptom duration was 10 (SD 8.0) years, and the mean number of tender points was 16 (SD 2.0). They were randomized to resistance exercise (n=67) and relaxation (n=63). A total of 104 patients completed the post-test examination, 56 (84%) of them belonging to the resistance-exercise group and 48 (76%) to the relaxation group.
Results The 6MWT (p=0.003), FIQ total (p=0.038) and VAS for current pain (0.033) significantly improved in the resistance exercise group when compared to the relaxation group. Also quadriceps muscle strength (p=0.010), biceps muscle strength (p=0.029) and ESES (p=0.020) significantly improved in the resistance exercise group when compared to the relaxation group.
Conclusions Resistance exercise resulted in significant improvement in physical function, health status and pain. The person-centered mode of exercise, adjusted to each patients' limitations and resources, can be recommended as it was found to be a feasible mode of exercise in patients with FM, also increasing the patients' self-efficacy for exercise.
Busch AJ, Webber SC, Richards RS, et al. Resistance exercise training for fibromyalgia. Cochrane database of systematic reviews. 2013; 12: CD010884.
Wolfe F, Smythe H, Yunus M, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990; 33: 160-72.
Burckhardt C, Clark S, Bennet R. The Fibromyalgia Impact Questionnaire. J Rheumatol. 1991; 18: 728-33.
Disclosure of Interest None declared