What is fibromyalgia syndrome (FMS) and how can exercise help?
Fibromyalgia Syndrome is a syndrome of widespread body pain. People with FMS often feel tired, stiff, anxious, and cannot get a good night's sleep. Research has shown that many people with FMS have less physical endurance than others. These low levels of fitness may be due to the pain, fatigue and depression of FMS, but research suggests that people with FMS are able to exercise and that exercise may improve overall fitness, as well as help reduce pain and improve symptoms.
How did the scientists find the information and analyse it?
The scientists working with the Cochrane Musculoskeletal Group searched scientific journals for studies testing exercise in people with FMS. Not all studies found were of a high quality and so only those studies that met the high standards of the Cochrane Collaboration were selected.
The studies selected to include in this summary had to meet the following scientific standards:
studies had to be randomised trials - studies that compare patients who exercised to patients who did not exercise or who received a different treatment
the studies had to show how well exercise works and its safety by using accepted measurements
Which high quality studies were included in the summary?
Studies that tested aerobic performance, strength, flexibility or any combination of these exercises in patients who were diagnosed with FMS by medical criteria were included. Sixteen studies were found and tested a total of 724 FMS patients, most of whom were women and between the ages of 31 and 55. The average number of patients in the smallest groups who exercised in each of the sixteen studies was 16.
Most of the conclusions from the summary are based on seven of the sixteen studies that were very high quality.These studies included exercises that met the American College of Sport Medicine guidelines for improving physical fitness. These guidelines require that aerobic exercises are for at least 20 minutes continuously or spread throughout the day for 2 days per week for 6 weeks and achieve a specific heart rate; strength exercises are for 2-3 days per week and include at least one set of 8-12 repetitions for each exercise; and flexibility exercises are to a position of mild discomfort and include 3-4 repetitions of each stretch for 10-30 seconds at least 2 days per week.
There were four studies that tested aerobic exercises including cycling, walking, whole body or dance aerobics over 6 to 20 weeks (2 studies tested at 2 or 4.5 years also).
There was one study that tested strength exercises including squats, knee and trunk extensions and bench presses, over 21 weeks.
There was one study that tested an aerobic programme (walking), strength and flexibility exercises over 6 weeks.
There were two studies that tested a combination of exercise and another treatment: aerobic exercise plus education and aerobic exercise plus biofeedback (this last study was also one of the four aerobic studies listed above).
Did symptoms improve with exercising?
Aerobic exercises after 6 to 20 weeks
aerobic fitness/performance improved on average by 17% in patients who did aerobic exercises and 0.5% in patients who did not - thresholds to pain improved on average by 28% in patients who did aerobic exercises but became worse by 7% in patients who did not
pain intensity decreased on average by 11% in patients who did aerobic exercises but increased by 1.6% in patients who did not
overall well-being improved in patients who did aerobic exercises
sleep, fatigue, sense of well-being, confidence in performing tasks and physical function improved in some studies but did not in other studies
psychological function, such as depression or anxiety, improved equally in patients who exercised and in patients who did not
Strength exercises after 21 weeks (results from one study)
pain, muscle fitness and mood improved in patients who did strength exercises more than in patients who did not - sleep and fatigue changed about equally in patients who exercised and in patients who did not
Combined exercise programme after 6 weeks (results from one study):
aerobic fitness and thresholds to pain improved more in patients who had a combined exercise programme compared to patients who did not
Aerobic exercise and education or biofeedback:
there were no differences between the patients who exercised with biofeedback or without biofeedback
There were three studies that tested exercises for longer than 21 weeks - two were able to follow the patients during that time. One study showed that patients reported better physical function and greater confidence in performing daily tasks after 1 year of exercise; and the other study showed that patients who exercised for 6 months had greater confidence in performing daily tasks, less fatigue and showed more improvement in the 6-minute walk test (a test for the ability to do activities of daily life) than patients who did not exercise.
Did people with FMS have any difficulties during or after exercising?
Many of the studies did not clearly report whether difficulties occurred or did not occur. Some studies reported that patients complained of increased symptoms of FMS, while other studies reported the opposite. Symptoms that were noted in a few patients doing aerobic exercises were brief knee pain, chest pain, hip pain and stress.
On average, more people who were exercising dropped out of the studies compared to people who were not exercising: 25 out of 100 people who exercised dropped out while 12 out of 100 people who were not exercising dropped out. Whether people dropped out because of difficulties with exercise is not known.
What did the scientists conclude about exercise for treating FMS?
Aerobic exercises up to 20 weeks, such as cycling, walking or whole body or dance aerobics that meet the ACSM guidelines, can result in better aerobic fitness, less pain tenderness and overall well-being. It may or may not result in less pain, better sleep and less fatigue. Anxiety and depression should not be expected to improve with aerobic exercise of less than 20 weeks.
Strength exercises may result in short term improvements in pain, muscle performance and mood but not in fatigue or sleep.
Flexibility exercises and combining different types of exercises may or may not be beneficial.
What are some considerations about exercise?
It is important to remember that regular aerobic exercise can improve physical fitness and provide other health benefits even when not specifically targeted to improving symptoms of FMS. Physical activity, as opposed to an organized exercise programme, also provides benefits and may be beneficial to people with FMS - more research is needed in this area.
Most of the studies tested exercise over 6 to 20 weeks and therefore more studies need to be done to determine the effects of exercise after 20 weeks.
More information about side effects or difficulties with exercises is necessary to determine whether there are some people with FMS who cannot tolerate exercise.
From the Cochrane Systematic Review by Busch A, Schachter CL, Peloso PM, Bombardier C. Exercise for treating fibromyalgia syndrome (Cochrane Review). In: The Cochrane Library, Issue 4 2002. Oxford: Update Software.
