Fibromyalgia (FM) is characterized by widespread pain lasting longer than three months (Rooks, 2007). It is a common complex disorder whose cause and exact mechanisms remain unclear. Current recommended treatments include pharmacological management, psychological interventions, and exercise (Häuser et al., 2012). Other treatments may also include self-management education and alternative therapies.
Scientific research shows that patients with FM are sometimes deconditioned and have low levels of cardiorespiratory endurance and decreased muscular strength and endurance (Busch et al., 2008). Patients are often directed to exercise by a pain specialist, but it is difficult for patients to know where to start.
In this blog, we will address some of the research findings on exercise for patients with FM. Exercise interventions are mainly broken down into aerobic, strength and flexibility. Many of today’s popular exercises combine all of these aspects.
In a meta-analysis (a large study that combines the results of smaller studies) by Busch et al., (2009), they found that aerobic exercise was associated with significant improvements on global well-being, aerobic physical function and depression, but not pain or tender points. When looking at strength training, they found that it resulted in large improvements of global well-being, physical function, pain, tender points and depression. The authors also reported that strength or aerobic exercise achieved greater results in tender points, physical function and global well-being than flexibility training. The authors also suggest that warm water (aquatic) exercise may be better tolerated by FM patients and that class environments offer an added social benefit. Further, it may lead to higher adherence due to its reduced impact and pleasant environment. Participation in aquatic exercise does improve well-being and depression yet offers less improvements in physical function when compared with land based exercise.
Häuser et al., (2010) conducted a systematic review and meta-analysis on different types of aerobic exercise in FM patients. In contrast to Busch et al. (2009), the authors found that aerobic exercise reduced pain (as well as improved fatigue, depression, physical fitness and health related quality of life (HRQOL)) at post treatment. However aerobic exercise had no effect on pain at follow up. To aid in prescription, the authors also found that low intensity aerobic exercise (<50% maxHR) is not effective and that aerobic exercise must be performed at least 2-3 times per week for 4-6 weeks to notice improvements. It is also necessary to continue aerobic exercise in order to maintain improvements in pain. The authors also reported that the addition of stretching or strengthening with aerobic exercise is no more effective than aerobic exercise alone. This again conflicts with the results of Busch et al. (2009) findings that strength training offers improvements over wider outcomes than AE.
More recently, research is showing that exercises such as Tai Chi (Wang et al., 2010) and Yoga (Mist et al., 2013, Wren et al., 2010, Carson et al., 2010) can be beneficial for pain, fatigue and mood. Neil Pearson, a physiotherapist and yoga teacher offers some specific yoga workshops for people with pain here: www.lifeisnow.ca
To date, there appears to be a lack of research or reporting on the adverse effects of exercise in FM. Although exercise appears beneficial on quality of life, physical function, depression and pain, it is difficult to make specific FM recommendations (despite some attempts): The Ottawa Panel recommends strengthening exercises as a treatment for FM (Brosseau et al., 2008). However, it has also been suggested that to minimize pain or adverse effects, exercise must be progressive: starting with muscle relaxation and progressing to flexibility training, resistance training and finally aerobic training (Thomas and Blotman, 2010).
Rather than having a generic approach to exercise for FM, it may be better to find exercises that you would most likely enjoy and adhere to longer term (Busch et al., 2009). Exercise does not have to include ‘gym’ work and could consist of structured increased activity around the home to start with (Gowans, 2010).
The take home message here is that movement and exercise are very beneficial. Land based exercise including aerobic, strength work, Yoga or Tai Chi may be good places to start but more importantly, start with an activity that you enjoy and can practice frequently. The activity should be started slowly and progressed gently. Working into some discomfort and increased pain may be required, but the intensity should not cause your pain to flare for hours and hours to the point where you become debilitated. Seek help from a health care professional that understands chronic pain conditions for more specific advice and consult your family doctor before starting an exercise regime.
Roland Fletcher, Registered Physiotherapist
Dr. Aaron MacINNES, Anesthesiologist & Pain Specialist