Exercises For Treating Fibromyalgia Syndrome

EXERCISES FOR TREATING FIBROMYALGIA SYNDROME Ms. Sweeta Priyadarshini Physical Therapy Intern Christian Medical College

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Cochrane Database of Systematic Reviews 2007

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Busch AJ, Barber KA, Overend TJ, Peloso PMJ, Schachter CL

Chronic widespread pain illness  Muscular Rheumatism/Fibrositis  2% of the general population  F:M :: 9:1 (ACR)  20-50 yrs 

ETIOLOGY Genetic Predisposition  Stress-induced  Sleep disturbance  Hormonal: reduction in dopamine/serotonin/HGH  Co-morbidity 

CLASSIFICATION Primary  Secondary: Physical injury, Surgery , Hepatitis 

FEATURES:   

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Pain, fatigue Tender points Headaches; TMJ/ Facial pain Paraesthesias Sleep disturbances Brain fog/Fibrofog: cognitive dysfunction Depression

OTHER SYMPTOMS:  Irritable bowel syndrome  Restless leg syndrome  Temperature sensitivity  GI complaints   

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Skin Complaints Chest Symptoms Inco-ordination/ Imbalance Dysmenorrhea

Dx – ACR CRITERIA 1990 

Chronic widespread pain for at least 3 months

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Pain in all 4 quadrants of the body; At least one point in each quadrant

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Pain on digital palpation with a 4-kg force in 11/18 tender points

MANAGEMENT   -

Pharmaceutical: Analgesics Dopamine, serotonin Anti-depression, anti-seizure drugs Muscle relaxants CNS stimulants Non-drug Rx: Psychological/ behavioural therapy

OBJECTIVE Effect of exercise training including -Cardiorespiratory (aerobic) -Muscle strengthening, -and/or Flexibility exercise on: 

Global wellbeing,  Selected signs and symptoms, and  Physical function in individuals with FMS 

METHOD 

34 RCTs; 2276 subjects(1264)

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Inclusion criteria: ACR

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Exclusion criteria: medical conditions C/I exs.

PRIMARY OUTCOME MEASURES 1. Pain 2. Global well-being: Fibromyalgia Impact Questionnaire (FIQ) 3. Physical function: -Aerobic: 6MWT, Ergometer -Strength: grip, hip/knee extension strength -Flexibility: sit and reach test

4.Tender points: Dolorimetry, TP count

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SECONDARY OUTCOMES

5. Depression: Beck Depression Inventory 6. Fatigue and sleep: FIQ fatigue scale and sleep VAS

ACSM GUIDELINES 2006  

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AEROBIC TRAINING ×6wks F: 3/week I: 40% HRR (min-max: 40-85%) or 64% predicted MHR (min-max: 64-94%) T: at least 20 mins duration T: use of major muscle groups Walking, cycling, swimming

MUSCLE STRENGTHENING F: 2-3 days per week  I: RM of each exercise  T: min. of 1 set of 8-12 reps  T: any type of strengthening exercise that can be progressed over time  Hip extn/abd/add.; Knee extn./flx.; Upper limbs 

FLEXIBILITY TRAINING F: twice a week  I: to a position of mild discomfort  T: 3-4 reps for each stretch ×10-30 secs  T: static stretching, AROM, neck and extremity stretches 

RESULTS AEROBIC ONLY:  Positive effect : global well being and physical function  Insignificant on: pain, TP  Conflicting: depression and fatigue STRENGTH TRAINING:  Limited evidence

FLEXIBILITY ONLY:  Limited  No effect on TP or depression MIXED: -inadequate number of studies

IMPLICATIONS FOR PRACTICE Moderate quality evidence (aerobic) - global outcome measures - physical function - possibly pain and tender points 

Limited evidence (strength) -pain, global wellbeing, physical function, TP and depression 

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Insufficient evidence on effects of flexibility exercise