Group Exercise, Education, and Combination Self-Management in Women with Fibromyalgia: A Randomized Trial

Fibromyalgia is a complex, poorly understood disorder characterized by diffuse chronic pain, fatigue, disturbed sleep, depression, and low tolerance for physical exertion.  Pharmacological treatments are often helpful but rarely resolve symptoms and significantly improve functional capacity.  Rooks and colleagues (Archives of Internal Medicine, 2007;167 (20): 2192) conducted a trial to investigate the effects of exercise on physical, social, and emotional function and symptoms among adults with fibromyalgia.

Methods:

Adults with fibromyalgia were randomly assigned to one of four different study conditions: (1) aerobic and flexibility exercise (AE); (2) strength training, aerobic, and flexibility exercise (ST); (3) fibromyalgia self-help course (FSHC); and a combination of ST and FBSHC.  Assessments of physical function included the Fibromyalgia Impact Questionnaire (FIQ), six-minute walk times, and walking speed, while the Medical Outcomes Short-Form-36 was used to evaluate social and emotional function.  Finally, depression and self-efficacy were also assessed by questionnaire.  Study participants completed the assessments at baseline, after the 16-week intervention, and at 6-month follow-up.

Results:

A total of 207 women participated in the study, 135 of which (65%) completed all assessments.  All groups had improved FIQ scores.  The greatest improvement (12.7 units) was obtained in the ST-FSHC, followed by AE (8.2 units), ST (6.6 units), and FSHC (0.3 units).  The ST-FSHC and AE groups had similar improvements on SF-36 scores pertaining to physical function and bodily pain.  The beneficial effects of the AE and ST alone and in combination with FSHC were maintained at 6-months.

Conclusions:

Twice weekly bouts of exercise (progressive walking, strength training and stretching) produced significant improvements in symptoms and physical functioning which were maintained at 6-months.  The benefits of exercise were enhanced when combined with education on the self-management of fibromyalgia.

Editorial Comment:

Fibromyalgia sufferers report that it is an unrelenting disease that makes it extremely difficult to try to lead a normal, active life.  The results of this study suggest that exercise can provide measureable benefits in symptoms and physical function.  Although this finding is not new, the results also suggest that exercise combined with education pertaining to self-management for fibromyalgia produces even better results than either exercise or education alone.

Several limitations of this study should be acknowledged.  First, the study did not include a traditional control group (a group that did not undergo any sort of intervention).  Thus, we are unable to evaluate whether simply being enrolled in a study produces benefits on the study outcomes.  Second, about one-third of participants dropped out of the study.  This is not surprising given the difficulty many people with fibromyalgia have tolerating physical exertion.  Nonetheless, it underscores the difficulty involved in prescribing exercise for fibromyalgia, and suggests that alternative strategies need to be developed that increase physical activity.  Finally, the study included only women.  Although women are 8 to 9 times more likely to develop fibromyalgia than men, it is vital to understand whether there are sex differences in response to exercise among people with fibromyalgia.

Kevin Fontaine, PhD

About Kevin Fontaine, PhD

Associate Professor of Medicine
Johns Hopkins University