# Exercise as it relates to Disease/Exercise as a treatment option for Fibromyalgia
#### What is Fibromyalgia?

Fibromyalgia (FM) is a chronic illness and is defined as having widespread pain to all four quadrants of the body for more than three months. FM patients, when examined by a GP will also have recognized pain in at least 11 of the 18 specified tender points. The etiology of FM is not fully understood but altered peripheral nociceptive mechanisms and central pain processing are considered to be the main reasons behind the illness. Across all ages, the prevalence of FM has been reported to be 1-2%.

#### Symptoms of FM

Individual’s suffering from FM may also experience a range of other symptoms that can impact on their daily lives. These symptoms include:
* Sleep difficulties
* Fatigue
* Stiffness / muscle cramps
* Irritable bowel syndrome
* Headaches/migraines
* Cognitive dysfunction
* Psychological distress

## Exercise and FM
#### Exercise as a treatment option

Exercise is often an under reported form of treatment for individuals suffering FM. Exercise has been reported to relieve symptoms and improve the overall quality of life in FM sufferers.
Many individuals with FM tend to be sedentary and therefore display below average levels of aerobic capacity, strength and flexibility. Individuals are physically able to participate in exercise but they often avoid it. Some common reasons for avoiding exercise are:
* Symptoms associated with FM (listed above) inhibit exercise
* Increased pain associated with micro-tears of the muscle
* A lack of perceived benefits associated with exercise
* Fear of worsening symptoms

#### Recommendations

Current recommendations state that aerobic exercise is the most effective form of treatment for FM. Aerobic programs need to include graded fitness exercises while intensity should be increased slowly. If an individual experiences any increase in their symptoms, the volume of exercise should be decreased until symptoms are reduced. Low to moderate exercise is most beneficial and can include sessions such as:
* Walking for 20 to 30 minutes, 2-3 times a week with a heart rate (HR) between 60-70% of max HR.
* Walking 2 x 10 minute sessions once a day
* Low impact cycling
* Modified low impact aerobic dance
* Warm water pool aerobics
Programs focusing exclusively on strength have also shown to provide some relief in symptoms. However, due to limited research it is unclear which exercises, volumes and intensities are best for FM sufferers.

#### Benefits

The most commonly acknowledged benefit of an exercise program in the treatment of FM, is the improvement in psychological well-being and subsequent quality of life. General benefits associated with exercise include:
| Aerobic only exercise | | Strength only exercise |
| Psychological benefits | Physical benefits | Psychological & physical benefits |
| Increased self efficacy Decreased feelings of helplessness Decreased depression Decreased anxiety | Increased physical function Increased aerobic capacity Decreased muscle tension Decreased fatigue Decreased number of tender points/ overall pain Reduced sensitivity at specified tender points | Decreased depression Increased aerobic capacity Increased quality of sleep Decreased fatigue Decreased number of tender points/ overall pain |

#### Considerations

For optimum relief an aerobic exercise program needs to be completed on a regular basis. An inconsistent schedule of exercise does not allow the body to develop resilience to initial pain. Trainers and instructors should also be aware that dropout rates are high because many people with FM have difficulty sticking to an exercise program.

#### Other treatments

Other treatment options for FM include education, cognitive behavioral therapy (CBT) or pharmacotherapy.

## Recommended Further Research

* There is currently limited research into the relationship between strength only exercise and the benefits for FM
* There are currently no studies looking into the effects of flexibility as a form of FM treatment
* There needs to be further study conducted regarding possible treatment options e.g. aerobic versus strength only, strength only versus flexibility and combinations of these treatments
* Studies need to assess the effect of varied exercise intensities and environments e.g. aquatic versus terrestrial
* High drop out rates need addressing
* Exploring other treatment options e.g. psychological in combination with exercise.

## List of Recommended Readings

* Mayo Clinic - Fibromyalgia by the Mayo Foundation for Medical Education and Research
* Fibromyalgia Professional Resource Center from the National Fibromyalgia Association
* Questions and Answers about Fibromyalgia by NIH

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Busch A, Barber K, Overend T, Peloso P, Schachter C. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev 2007;4(4).
* 1 2 3 Fibromyalgia Network [Internet]. Tucson: Fibromyalgia Netwrok; c1988 [cited 2013 Oct 21]. Available from http://www.fmnetnews.com
* 1 2 Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis & Rheumatism 1995;38(1):19-28.
* ↑ Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism 1990;33(2):160-172.
* 1 2 3 4 5 6 7 8 9 10 11 Bircan Ç, Karasel SA, Akgün B, El Ö, Alper S. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatol Int 2008;28(6):527-532.
* 1 2 3 4 5 6 7 8 9 Richards SC, Scott DL. Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. BMJ: British Medical Journal 2002;325(7357):185.
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Meyer BB, Lemley KJ. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. Med Sci Sports Exerc 2000;32(10):1691-1697.
* 1 2 3 4 5 Ramsay C, Moreland J, Ho M, Joyce S, Walker S, Pullar T. An observer‐blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Rheumatology 2000;39(5):501-505.
* 1 2 3 4 5 6 Mannerkorpi K, Iversen MD. Physical exercise in fibromyalgia and related syndromes. Best Practice & Research Clinical Rheumatology 2003;17(4):629-647.
* 1 2 3 Saltskår Jentoft E, Grimstvedt Kvalvik A, Marit Mengshoel A. Effects of pool‐based and land‐based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis Care & Research 2001;45(1):42-47.
* ↑ Brosse AL, Sheets ES, Lett HS, Blumenthal JA. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Medicine 2002;32(12):741-760.