EXERCISES FOR TREATING FIBROMYALGIA SYNDROME

Ms. Sweeta Priyadarshini Physical Therapy Intern Christian Medical College

Cochrane Database of Systematic Reviews 2007 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 Pain in all 4 quadrants of the body; At least one point in each quadrant 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) Inclusion criteria: ACR 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

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

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