Are Improvements in Physical Fitness after an Exercise Program Related to the Symptomatology in Patients with Fibromyalgia

Beginning of article

INTRODUCTION

Fibromyalgia is a chronic rheumatic condition consisting of diffuse musculoskeletal pain, fatigue, sleep disturbances and tenderness on palpation (Wolfe et al., 1990). While the concept of central sensitization is increasingly accepted as an important pathophysiologic aberration in FM patients, the factors that contribute to its persistence are not well-characterized (Price and Staud, 2005). FM patients have low levels of physical fitness and often experience post-exertional pain, fatigue and delayed onset of muscle soreness (Jones et al., 2006).

Conventional medical treatment generally produces modest and inconsistent benefits on symptoms, functioning and quality of life (Gore et al., 2009); therefore, nonpharmacologic treatments, such as exercise and cognitive-behavioral interventions, are recommended to assist people with FM to better manage the array of symptoms and functional deficits (Gore et al., 2009). Scientific evidence supports the use of physical exercise program for the overall management of this population group (Busch et al., 2008). Improvements have been reported among others in pain relief, sleep quality, stiffness, anxiety or depression (Assis et al., 2006; Bircan et al., 2008; Gusi et al., 2006; Tomas-Carus et al., 2005 Valkeinen et al., 2008). Despite this, the symptoms of FM often create obstacles that deter many from exercising consistently enough to derive benefits (Jones and Liptan, 2009). Thus, finding new ways to promote increased physical activity in persons with FM that can be sustained overtime is important. Therefore the aim of the current study was twofold, first to assess whether the exercise training have any effect on physical fitness and second to determine whether any change in aerobic capacity, strengthening or flexibility after exercise training is associated with improvements in symptoms severity.

METERIALS AND METHODS

Participants: A total of 30 women who met the American College of Rheumatology criteria for classification of FM (Wolfe et al., 1990) had to give written informed consent to be involved in the study. Participants were randomized to either combined exercise group (CE, n = 15) or usual care control group (CG, n = 15).

The exclusion criteria included the presence of inflammatory rheumatic diseases and severe psychiatric illness. Participants with respiratory or cardiovascular diseases that prevent physical exertion were also omitted. Finally, women with FM receiving psychological or physical therapy were excluded to avoid possible interactions with the present trial. This research was approved by the University of Seville Research Ethics Committee.

Outcome measures: Assessment of outcomes was undertaken at baseline and immediately after the 12-week intervention and at the same time points in the usual care control group. The …