People who have fibromyalgia syndrome can suffer from chronic widespread pain creating difficulty with day-to-day tasks that can often be frustrating to the individual.

Despite the general health benefits associated with exercise, people with fibromyalgia syndrome are often reluctant to undertake exercise, as they perceive a risk of exacerbating their symptoms. So what are the best exercise programmes for people with fibromyalgia?

A recent systematic review has evaluated the effect of exercise on aerobic functional capacity in adults with fibromyalgia syndrome.

Here’s what they did

The authors searched 7 electronic databases looking for randomised controlled trials that evaluated the effects of exercise compared with a control on aerobic functional capacity in adults with fibromyalgia syndrome.

Physical exercise included; aerobic, strength, combined, aquatic and multidisciplinary.

Control groups included; no exercise, education or usual care.

Quality of the studies were evaluated using the Physiotherapy Evidence Database scale.

Here’s what they found

• 13 studies were included.
• Exercise types included; aerobic n=3; strength n=2; combination n= 2; aquatic n=4; and multidisciplinary n=3
• Exercise programmes ranged from 6 to 24 weeks, with 0.5 to 3 sessions per week and session duration ranging from 20 to 60 mins.
• Functional aerobic capacity (6-min walk test) was found to improve with aerobic exercise (Effect size (ES)=0.85; 95% CI, 0.57-1.12) and aquatic exercise (ES=0.44; 95% CI, 0.15-0.73),
• Strength training and the multidisciplinary programmes were not found to improve function

The authors concluded

Physical exercise (aerobic and aquatic exercise) performed at least 2 times per week and 30-60min per day is effective for increasing functional aerobic capacity in adults with fibromyalgia syndrome.

Aerobic and aquatic exercise is effective for increasing functional aerobic capacity in adults with fibromyalgia.

The Musculoskeletal Elf’s view

Physical exercise has been used as common practice to assist in the improvement of symptoms for people with fibromyalgia. However there is little guidance in clinical guidelines for exercise prescription in this population. This is further complicated as there are many associated symptoms in people with fibromyalgia and many guidelines need to provide generic guidance. This systematic review has provided an important starting point for individuals with fibromyalgia syndrome looking to introduce an exercise routine.

The recommended standard of the American College of Sports Medicine for exercise programmes is 2 sessions of 20 min duration per week. Interestingly all the studies included in this review met this minimum standard.

What do you think?

• Do you prescribe exercise for patients with fibromyalgia?
• What type of exercise do you find to be the most effective?
• How do you determine what intensity to start the patient on, and what progression parameters do you employ?

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Links

• Effects of exercise on functional aerobic capacity in adults with fibromyalgia syndrome: A systematic review of randomized controlled trials. García-Hermoso A, et al. J Back Musculoskelet Rehabil. 2014 Nov 18