Resistance, Aerobic Training May Reduce Pain in Fibromyalgia

Janis C. Kelly

January 31, 2014

The trend toward including exercise training in fibromyalgia (FM) treatment programs gained support from a Cochrane Collaboration review published online December 20, 2013. The reviewers found that resistance training was both beneficial and safe for women with FM and that aerobic exercise helps reduce FM pain.

However, they caution that these conclusions were supported by low-quality evidence, as was the conclusion about the safety of moderate- to high-resistance training in FM.

Lead author Angela J. Busch, PhD, associate professor in the School of Physical Therapy at the University of Saskatchewan College of Medicine, Saskatoon, Canada, told Medscape Medical News that the review's key findings were that moderate-intensity and moderate- to high-intensity resistance training improved multidimensional function, pain, tenderness, and muscle strength in women with FM and that aerobic exercise was superior to moderate-intensity resistance training for improving pain in women with FM.

"Clinicians often shy away from resistance exercise for this population," Dr. Busch said. "It appears that people with FM can benefit from this form of exercise, but we noted that the programs we examined involved supervised exercise and started low and gradually increased the resistance. There are particular health benefits associated with resistance exercise (eg, increasing bone strength, which is important for preventing osteoporosis), so it is good to know that clinicians can safely use this form of exercise. We are now reviewing literature on aquatic exercise protocols and mixed exercise protocols, which may provide further information for clinicians."

Just 5 Randomized Trials Found

The authors' main objective was to evaluate the benefits and harms of resistance exercise training in adults with FM. The researchers searched 9 electronic databases and other sources for published studies and screened 1856 citations, 766 abstracts, and 156 full-text articles. They found 5 studies that met their inclusion criteria: randomized clinical trial, FM diagnosis based on published criteria, adults, full-text publication, and between-group data comparing resistance training with a control or other physical activity intervention.

The studies included 219 women with FM, 95 of whom were assigned to resistance training programs. Three trials compared 16 to 21 weeks of moderate- to high-intensity resistance training with a control group. Two studies compared 8 weeks of progressive resistance training with aerobic training. One study compared 12 weeks of low-intensity resistance training with flexibility exercise.

"Although there were 7 separate publications, there were only 5 included studies. In total, there were 241 participants in the included studies, and of these, there were 219 women with [FM]. This is not many people to make major conclusions," said Bryan T. Walitt, MD. Dr. Walitt, who was not involved in this study, is medical director of the Georgetown University Fibromyalgia Center in Washington, DC.

However, the analysis showed statistically significant differences favoring resistance training in multidimensional function (measured using the Fibromyalgia Impact Questionnaire), in self-reported physical function, in number of tender points, and in muscle strength (leg extension).

There was a statistically significant reduction in pain that favored aerobic exercise over resistance training, but no significant differences between these 2 types of exercise were seen in multidimensional function, self-reported physical function, or tenderness.

Resistance training was significantly more effective than flexibility exercise for multidimensional function and pain, but not for tenderness or strength.

Dr. Busch agreed there were limitations to the study. "These results are based on a few small studies, so we are somewhat cautious," Dr. Busch said. In addition, she and her colleagues classified the evidence as low quality and noted there was a risk for bias.

The mean change in pain using a 0- to 10-cm visual analog scale at 8 weeks' follow-up was −3.57 cm with aerobic training vs −2.7 cm with resistance training. Mean change in pain at 12 weeks' follow-up was −1.01 cm with flexibility exercise vs −1.89 cm with resistance training.

Dr. Walitt commented that even the larger changes reported were only slightly greater than the minimally important clinical difference of 2 cm. "These are not 'I'm better' numbers," he noted.

Adverse effects were, in general, poorly documented, but there were no serious adverse effects reported for any intervention and no statistically significant differences in attrition rates between the interventions. "We were surprised that women (pre- and postmenopausal) with FM were able to successfully perform resistance exercise. Only a few transient adverse effects were observed," Dr. Busch said.

"The data appear to show that these types of exercise can lead to minor to moderate improvements in how people perceive their bodies. It does not show that exercise makes people better," Dr. Walitt concluded.

The authors and Dr. Walitt have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online December 20, 2013. Abstract

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