# Exercise as it relates to Disease/Exercise and Cognitive Behavioral Therapy Effects on Females with Fibromyalgia

This is an analysis of the journal article “Long-Term Efficacy of Therapy in Patients With Fibromyalgia: A Physical-Based Program and a Cognitive-Behavioral Approach” by Redondo, J. R., Justo, C. M., Moraleda, F. V., Velayos, Y. G., Puche, J. J. O., Zubero, J. R., Herna´ndez, T. G. Ortells, L. C. and Pareja, M. A. V.

## What is the background to this research?

Fibromyalgia is a chronic neurologic condition which affects primarily middle-aged women. The patients who suffer from Fibromyalgia experience pain all over their body, which leads to severe fatigue, trouble with memory, thinking clearly and issues with having a restful sleep. Studies have hypothesized that Fibromyalgia stems from a disruption on a neurological level. The cause behind Fibromyalgia is yet to be identified, though in some patients it has been linked to genetics, mental health and sex/gender. As there is no cure for Fibromyalgia, current treatment is designed to lessen symptoms. Doctors will prescribe medications aimed at aiding in sleep, dulling overactive nerves and altering hormones to aid patient’s ability to cope with pain. Other methods of treatment include lifestyle changes such as partaking in physical exercise (PE) and seeing a counsellor/psychologist, where cognitive behavioural therapy (CBT) is used. Fibromyalgia reduces the quality of a patient’s life and thus, their physical activity levels, the afore mentioned study is utilising PE and CBT to assess the long-term effectiveness on the persistence symptoms of Fibromyalgia.

## Where is the research from?

The Study was conducted by Redondo, J. R., MD., Justo, C. M., Moraleda, F. V., Velayos, Y. G., Puche, J. J. O., MD., Zubero, J. R., MD., Herna´ndez, T. G., MD., Ortells, L. C. and Pareja, M. A. V., PhD, through the Instituto Provincial De Rehabilitacion, Hospital Universitario Gregorio Marañón, Madrid, Spain. It was then published by the American College of Rheumatology. This study was approved by the ethical committee of the hospital Universitario Gregorio Marañón, Madrid, Spain.

## What kind of research was this?

This was a long term, randomised, parallel clinical trial that utilised questionnaires and physiological assessments to obtain quantitative data. Though medication was consumed by subjects, the effects of it was not a focus of this study.

## What did the research involve?

56 females partook in this study which later decreased to 31, due to a variety of reasons. For a subject to be applicable for participation in the study they first had to meet the criteria for Fibromyalgia diagnosis laid out by the American College of Rheumatology. This allowed for there to be a level of standardisation in participant choice. The successful participants were split into two randomised groups; one for cognitive behavioural therapy (CBT) (n=16) and one for physical exercise (PE) (n=15), where each underwent four sets of assessments; a baseline, 8 weeks post treatment, 6 months post treatment and 1 year post treatment. Each assessment included self-questionnaires, physical activity and aerobic exercise capacity (using an incremental exercise test on a cycle ergometer). These methods looked at the ways in which fibromyalgia affects physical functioning (work, stiffness, quality of life, general health and social functioning), mental health (anxiety and depression), pain (effects on physical movement, coping mechanisms and self-efficacy), sleep, fatigue and physiological effects whilst exercising. Self-reporting questionnaires can come with self-bias which can interfere with study results, as pain is a subjective thing, this is an appropriate method of monitoring perceptual improvements. The two groups underwent 8 weeks of treatment. The CBT group, led by psychologists, consisted of weekly sessions, lasting 2.5 hours that addressed methods aiding and improving in pain management and self-efficacy. The PE group underwent 5x45 minute sessions weekly; 1x warm water pool, 2x flexibility and endurance and 2x cardiovascular fitness, utilising cycle ergometers and weights for isokinetic exercises. The exercises for the PE group were increased in difficulty each week. The subjects were advised to continue partaking in PE post treatment. Whilst subjects had been advised of this there is no mention of how they monitored the subjects at home activity, which could lead to post treatment results being inapplicable and invalidating this study.

## What were the basic results?

In the short-term there were improvements, as time progressed those measures returned to near baseline measurements. At the 1 year post treatment assessment, the results for functional capacity and physical activity for the PE group were slightly better than baseline measurements, thought statistically insignificant. The CBT group results all returned to near baseline 1 year post treatment. The subjects continued to use relaxation techniques from treatment despite this, they reported a higher need for analgesic medication at the 1 year post treatment assessment compared to baseline measurements, though these differences weren’t statistically significant.

## What conclusions can we take from this research?

Subject from both groups initially showed improvement in their clinical manifestations, pain had been reduced immediately after treatment. The only group to show improvements in physical fitness and the ability to perform aerobic exercise was the PE group, while the CBT displayed improvement in their self-efficacy and learning to cope with their pain, which improved their Fibromyalgia symptoms. Between post treatment and the 1 year post treatment assessment, no mention of how subjects were monitored/reported their continuation of treatment, which could be the cause behind the drop off in improvements. This limitation can be rectified by a repeat of this study with consistent monitoring for the year post treatment to ensure subjects are continuing methods acquired from the treatment period at home.

## Practical Advice

Studies from a meta-review of exercise therapy for patients with Fibromyalgia, found aerobic exercise reduces depression, fatigue and pain as well as improving quality of life and physical fitness. Strength training has been found to significantly improve patient well-being and their physical functioning. A combination of flexibility, aerobic and strength training has been found to improve physical functioning and pain in subjects. These results are applicable with what has been concluded in this review. Patients with Fibromyalgia can take into consideration this information when considering their choice of exercise and build up on it. Keeping in mind that subjects post treatment exercise wasn’t monitored, patients should maintain adequate PE in their daily lives to suit their symptom management for best results. Methods to maintain motivation through the pain will aid in this.

## Further Information

For further information on fibromyalgia, its treatments and topics mentioned within this article and those of the original, please follow the bellow links:
* Information and support: https://www.myfibroteam.com/
* Finding the perfect support network: https://paindoctor.com/fibromyalgia-support-groups/
* Further, more in-depth information: http://www.racgp.org.au/afp/2013/october/fibromylagia/
* Information leaflet: http://rheumatology.org.au/downloads/Fibromyalgia_000.pdf
* Further information and support: https://emerge.org.au/diagnosis/related-conditions/fibromyalgia-fm/#.WdFhHWiCzIV

## References

* 1 2 3 4 5 6 Redondo, J. R., Justo, C. M., Moraleda, F. V., Velayos, Y. G., Puche, J. J. O., Zubero, J. R., Herna´ndez, T. G. Ortells, L. C. and Pareja, M. A. V., (2004), Long-Term Efficacy of Therapy in Patients With Fibromyalgia: A Physical Exercise-Based Program and Cognitive-Behavioral Approach, Arthritis and Rheumatism (Arthritis Care and Research), Vol. 51, No. 2, pp 184-192, DOI: 10.1002/art.20252
* 1 2 3 Bhana, S., (2017), Fibromyalgia, https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
* ↑ Ratini, M., (August 22, 2017), What Causes Fibromyalgia, http://www.webmd.com/fibromyalgia/guide/fibromyalgia-causes
* ↑ Mayo Clinic, (August 11, 2017), Fibromyalgia, http://www.mayoclinic.org/diseases-conditions/fibromyalgia/diagnosis-treatment/treatment/txc-20317826
* 1 2 Busch, A. J., Webber, S. C., Brachniec, M., Bidonde, J., Bello-Haas, V. D., Danyliw, A. D., Overend, T. J., Richards, R. S., Sawant, A., Schachter, C. L., (July 5th 2011), Curr Pain Headache Rep 15: 358-367, DOI: 10.1007/s11916-011-0214-2