What is the role of exercise in fibromyalgia rehabilitation?

Updated: Feb 07, 2019
  • Author: Regina P Gilliland, MD; Chief Editor: Dean H Hommer, MD  more...
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Some investigators have found that daily aerobic and flexibility exercises are an essential component of the rehabilitation program. [5] Exercise was first recognized to have therapeutic benefits in the late 20th century. At that time, patients were randomized to receive 20 weeks of high-intensity exercise or flexibility training. Improvements in fitness, global assessment ratings, and tender-point pain thresholds were greater in the high-intensity group than in the flexibility group. Subsequent clinical trials have confirmed the benefits of aerobic exercise and muscle strengthening on mood and physical functioning.

Patients should begin with gentle warm-up, flexibility exercises and progress to stretching all of the major muscle groups. Low-impact aerobic exercise is necessary at least 3 times weekly. Patients should always start at low levels of exercise and progress slowly. The goal is to exercise safely without increased pain. The patients' target exercise regimen is 4-5 times a week for at least 20-30 minutes each time; this may take the patient months to achieve.

Some patients with fibromyalgia may never be able to achieve this level of exercise; encourage them to exercise at the highest level possible without worsening their symptoms. [6]

Some investigators believe that aquatic exercise may be the safest and gentlest aerobic conditioning exercise available for this group. Aquatic therapy enables aerobic conditioning and also flexibility, strengthening, and stretching exercise. Aquatic exercise is well tolerated and is especially helpful for some patients.

A study by Wang et al indicated that tai chi is a more effective treatment for fibromyalgia than aerobic exercise. In patients who participated in tai chi twice weekly for 24 weeks, the Revised Fibromyalgia Impact Questionnaire score differed from that of patients who underwent the same schedule and duration of aerobic exercise by 16.2 points. [14]

A randomized, controlled trial by Larsson et al indicated that resistance exercise improves muscle strength (including isometric knee extension force and isometric elbow flexion force), raises health status (based on the Fibromyalgia Impact Questionnaire score), and reduces current pain intensity, in women with fibromyalgia. The study involved 130 women with the condition and included a person-centered program of progressive resistance exercise. [15]

Similarly, a study by Glasgow et al indicated that resistance exercise training significantly reduces disease impact in women with fibromyalgia. After 8 weeks of training, the one-repetition maximum for chest press and leg extension in patients was significantly increased. However, resistance training did not eliminate autonomic dysfunction, with controls having, for example, a lower resting heart rate than the fibromyalgia patients. [16]

A literature review by Andrade et al indicated that in patients with fibromyalgia, strength training can reduce pain, fatigue, depression, anxiety, and the number of tender points, while improving functional capacity and quality of life. [17]

A literature review by Sanada et al indicated that following exercise, dietary, or multidisciplinary intervention, patients with fibromyalgia undergo a reduction in serum interleukin-8 (IL-8) and IL-6, suggesting that such interventions have an anti-inflammatory effect. [18]

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