# Exercise as it relates to Disease/Endurance training to alleviate the pain of fibromyalgia

This is an analysis of the journal article “Patients with fibromyalgia benefit from aerobic endurance exercise” by Meiworm, Jakob, et al., (2000)

## Background

Fibromyalgia (FM) is a chronic condition characterised by altered pain processing, called central sensitization. FM affects tendons, muscles and ligaments resulting in widespread and persistent musculoskeletal pain “myalgia” and tender points (TP) around the body. FM often co-exists with other conditions, including chronic headaches, jaw and facial pain; irritable bowel syndrome; chronic fatigue syndrome; sleep disturbances; anxiety and depression. Despite extensive research, scientists have not yet discovered a single cause of FM. It is suggested that various physical and/or psychological factors as well as certain infections may play a role in developing FM. In recent decade, genetic basis have been proposed as a key cause for FM, with some studies reporting high familial predispositions.
The main goal in treating FM is to reduce the major symptoms of the condition and should include a multiple approaches
* patient education – sleep hygiene, role of various stressors, prognosis, reassurance that FM is real
* medications
* nonpharmaceutical interventions (exercise)
As FM patients associate physical activity with worsening of the symptoms it is of paramount importance to encourage them to engage in a graded cardiovascular (CV) program. CV activities, such as swimming, biking, or walking can reduce painful symptoms and decrease the number of TP

## Where Is This Research From

The experiment was conducted at the University Hospitals in Freiburg, Germany. Various departments, Division of Rheumatology and Clinical immunology, Division of Rehabilitative and Preventive Sports Medicine, and Department of Medicine anticipated in the research. The article was published in Clinical Rheumatology.

## What Kind Of Research Was This

The research team investigated whether the aerobic endurance exercise might improve FM symptoms. In this study participants diagnosed with FM who engaged in an exercise program for 12 weeks were compared with a control group.

## What Did The Research Involve

Out of 76 patients diagnosed with FM in the hospital’s reumathology clinic, 31 (29F, 2M) agreed to take part in the study. 27 participants finished the study. Prior to and after the study participants were screened for several factors:
* pain threshold
* negative TPs with a Fischer dolorimeter
* subjective pain, rated on a visual analogue scale
* spiroergometric evaluation with the analysis of breathing gases and lactic acid concentration
* ECG recordings
Over three months patients anticipated in a simple self-managed domestic training program:
* two to three, 20-30 minute long, training sessions per week, without intermittent resting
* at moderate intensity, 50% VO2 max,
* participants could choose their discipline from cycling, jogging/walking, swimming
* during the first 6 weeks, intensity was increased every fortnight by changing the duration or frequency of the sessions
The control group, to which the exercise sample was compared, continued their normal life.

## The Main Findings

Most participants from the exercise group showed a decrease in the number of TP, and in subjective pain as compared to the control group. These findings are similar to a number of other studies investigating the link of aerobic exercise and reduction in painful symptoms in FM. There was a significant decrease in the pain threshold in the gluteal TP, but not in the other eight sites.

## Other Findings

Statistical but not significant improvements in some parameters:
* lower LA concentration
* decreased HR, and improved aerobic work capacity (VO2max) at submaximal workloads
* Watt/heart rate at maximal workload
Improvements in above values are normal responses to physical activity interventions.

## Conclusion and Implications

Even though the paper reports similar findingss to a number of other research, the paper is not without faults. The very small sample group, n=27, and reliance on self-reported data make the results statistically insignificant. There was no comparison to a pharmaceutical form of FM treatment. Additionally, the research lacks analysis in regards to a wide range of symptoms, i.e. sleep disturbance, mental disorders, which greatly aggravate symptoms of FM. The authors clearly state that the aerobic physical activity is effective in alleviating pain in FM patients, however this cannot be regarded as a strong and valid argument.

## Further reading

For further information regarding the causes, symptoms, and treatment options of fibromyalgia; click on the links below.
* National Fibromyalgia Research Association http://http.www.nfra.net/
* National Fibromyalgia Association http://www.fmaware.org/
* Fibromyalgia and Chronic Fatigue Syndrome Forum https://www.verywell.com/fibromyalgia-and-chronic-fatigue-4014724

## References

* ↑ Meiworm L, Jakob E, Walker UA, Peter HH, Keul J. Patients with fibromyalgia benefit from aerobic endurance exercise. Clinical Rheumatology. 2000;19:253-257
* 1 2 Asrzi-Puttini P, Atzeni F, Mease PJ. Chronic widespread pain: from peripheral to central evolution. Best Practise $ Research Clinical Rheumatology. 2011; 25:133
* 1 2 Schmidt-Wickle T, Clauw DJ. Abnormal pain modulation in patients with spatially distributed chronic pain: fibromyalgia. Rheumatic Disease Clinics of North America. 2009; 35:263
* ↑ Goldberg DL. Fibromyalgia syndrome. An emerging but controversial condition. JAMA. 1987; 257(20):2782
* ↑ Aggarwal VR, McBeth J, Zakrzewska JM, et al. The epidemiology of chronic symptoms that are frequently unexplained: do they have common associated factors? International Journal of Epidemiology. 2006; 35
* ↑ Goldenberg DL. Do infections trigger fibromyalgia? Arthritis Rheumatology. 1993; 36:1489
* ↑ Buskila D, Sarzi-Puttini P. Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Research & Therapy. 2006; 8:218
* ↑ Arnold LM, Huddson JI, Hess EV, et al. Family study of fibromyalgia. Arthritis Rheumatology. 2004; 50:944
* ↑ Lauche R, Cramer H, Hauser W, et al. A systematic overview of reviews for complementary and alternative therapies in the treatment of the fibromyalgia syndrome. Evidence Based Complement Alternative Medicine. 2015
* 1 2 Bidonde J, Busch AJ, Webber SC, et al. Aquatic exercise training for fibromyalgia. 2014. Cochrane Database Systemic Review
* 1 2 Busch AJ, Webber SC, Richards RS, Bidonde J, Schachter CL,et al. Resistance exercise training for fibromyalgia. 2013. Cochrane Database Systemic Review.
* 1 2 Kaleth AS, Slaven JE, Ang DC. Does increasing steps per day predict improvement in physical function and pain interference in adults with fibromyalgia? Arthritis Care & Research. 2014; 66(12):1887-94