Recent Updates
Prescribed exercise in people with
Fibromyalgia:
parallel group randomised controlled trial.
Richards SC, Scott DL.
British
Medical Journal 2002 Jul 27;325(7357):185
Poole Hospital NHS Trust, Poole, Dorset BH15 2JB. srichards@poole-tr.swest.nhs.uk
OBJECTIVES: To evaluate cardiovascular fitness exercise in people with
Fibromyalgia.
DESIGN: Randomised controlled trial. Setting: Hospital rheumatology
outpatients. Group based classes took place at a "healthy living centre."
PARTICIPANTS: 132 patients with Fibromyalgia.
INTERVENTIONS: Prescribed graded aerobic exercise (active treatment) and
relaxation and flexibility (control treatment). MAIN OUTCOME MEASURES: Participants' self assessment of improvement, tender point count, impact of
condition measured by Fibromyalgia impact questionnaire, and short form McGill
pain questionnaire.
RESULTS: Compared with relaxation exercise led to significantly more
participants rating themselves as much or very much better at three months: 24/69 (35%) v 12/67 (18%), P=0.03. Benefits were maintained or improved at one
year follow up when fewer participants in the exercise group fulfilled the
criteria for Fibromyalgia (31/69 v 44/67, P=0.01). People in the exercise
group also had greater reductions in tender point counts (4.2 v 2.0, P=0.02)
and in scores on the Fibromyalgia impact questionnaire (4.0 v 0.6, P=0.07).
CONCLUSIONS: Prescribed graded aerobic exercise is a simple, cheap, effective,
and potentially widely available treatment for Fibromyalgia.
DR. PODELL’S COMMENTS: This is a well-designed study that compares the
effect on Fibromyalgia symptoms of slowly increased exercise with just
relaxation and flexibility training as a control group. Exercise wasn’t
perfect. Only 35% of the exercise group had improved at three months, but it
was much
better than non-exercise, from which only 28% improved. After one year, 55% of
the exercisers had recovered to the point where they no longer met the
diagnostic criteria for FMS. Only one-third of the non-exercisers had
progressed that far.
The main problem with this article though is that they don’t emphasize the
crucial Goldilocks Principle. Too much exercise makes people feel worse; so
does too little. What’s needed is just the right amount. The right
amount of exercise is an amount you can do without feeling worse later that day or the next day. Then increase in modest steps as your conditioning improves.
We
discuss this issue at some length in our main section on
Fibromyalgia.
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