Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial

Abstract

The purpose of this study was to evaluate and compare the effectiveness of muscle-strengthening exercises (MS) and a walking program (WA) in reducing pain in patients with fibromyalgia. Ninety women, 30-55 years of age, diagnosed with fibromyalgia according to the American College of Rheumatology 1990 criteria, were randomized into 3 groups: WA Group, MS Group, and control group. Pain (visual analog scale) was evaluated as the primary outcome. Physical functioning (Fibromyalgia Impact Questionnaire, FIQ), health-related quality of life (Short-Form 36 Health Survey, SF-36), and use of medication were evaluated as secondary outcomes. Assessments were performed at baseline, 8, 16, and 28 weeks. Intention-to-treat and efficacy analyses were conducted. Sixty-eight patients completed the treatment protocol. All 3 groups showed improvement after the 16-week treatment compared to baseline. At the 28-week follow-up, pain reduction was similar for the WA and MS groups (P = 0.39), but different from the control group (P = 0.01). At the end of the treatment, 80% of subjects in the control group took pain medication, but only 46.7% in the WA and 41.4% in the MS groups. Mean FIQ total scores were lower for the WA and MS groups (P = 0.96) compared with the control group (P < 0.01). Patients in the WA and MS groups reported higher scores (better health status) than controls in almost all SF-36 subscales. MS was as effective as WA in reducing pain regarding all study variables; however, symptoms management during the follow-up period was more efficient in the WA group.

To walk or not to walk: insights from a qualitative description study with women suffering from fibromyalgia

“…It is a rather common condition as its worldwide average prevalence is estimated 2.7 % in the general population, with a greater prevalence in women (4.1 %) than in men (1.4 %) [2]. Fibromyalgia affects many aspects of daily life and has serious personal and social implications [3,4].Though the treatment for fibromyalgia is still controversial, current evidence strongly suggests that the most effective intervention combines physical exercise, pharmacological treatment, and cognitive-behavioral therapy [5]. More specifically, it has been demonstrated that physical exercise is highly beneficial in (1) the management of pain; (2) the reduction in stiffness, fatigue, and depression; and (3) the adoption by patients of a more positive attitude toward the disease [6][7][8].…”

Association of Physical Fitness With Pain in Women With Fibromyalgia: The al‐Ándalus Project

“…Thus, increasing tissue oxygenation as a result of aerobic exercise could potentially diminish peripheral and central sensitization and reduce clinical pain (3). The exercise-induced endogenous opioid activity in the central and peripheral nervous system (37) could also partially justify pain reductions observed following exercise programs in FM (3,4).…”

“…We considered these covariates, as they are known potential confounders of the association under study (23)(24)(25). Because there is evidence suggesting that improving physical fitness might reduce pain (3,4), each pain-related outcome was treated as a dependent variable, and physical fitness measurements as independent variables, in all the analyses.…”

“…Physical fitness is a well-known powerful marker of health that might be enhanced through exercise programs. Intervention studies have shown concomitant increases in fitness with reduced levels of pain (3,4) and improved quality of life in FM patients. Likewise, low physical fitness has been related to exacerbated pain, fatigue, and stiffness (5) and to higher risk of falls in this population (6).…”

“…However, Henriksen et al (9) observed that the association between knee muscle strength and TPC in these patients was weak. The association of flexibility and motor agility with pain has received little attention (7,12), and exercise programs for the management of FM rarely focus on improving these fitness components (3,4).…”