Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review Aerobic fitness effects in fibromyalgia. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. Strengthening Exercises Improve Symptoms and Quality of Life but Do Not Change Autonomic Modulation in Fibromyalgia: A Randomized Clinical Trial Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. An exercise program in the treatment of fibromyalgia. The effect of brief exercise cessation on pain, fatigue, and mood symptom development in healthy, fit individuals. Predicting high physical function in people with fibromyalgia. Adherence during an individualized home based 12-week exercise program in women with fibromyalgia. Internet-enhanced management of fibromyalgia: A randomized controlled trial Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Fitness and perceived exertion in patients with fibromyalgia syndrome. Patients with Fibromyalgia Benefit from Aerobic Endurance Exercise A Successful, Long-Term Exercise Program for Women With Fibromyalgia Syndrome and Chronic Fatigue and Immune Dysfunction Syndrome Effects of an exercise programme on self-esteem, self-concept and quality of life in women with fibromyalgia: a randomized controlled trial Effects of short versus long bouts of aerobic exercise in sedentary women with fibromyalgia: a randomized controlled trial. A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol
Aim Previous systematic review s have found hydrotherapy to be an effective management strategy for  fibromyalgia syndrome ( FMS ) .  The aim of this systematic review was to summarize the components of hydrotherapy programs used in r and omized controlled trials . Method A systematic review of r and omized controlled trials was conducted . Only trials that have reported significant FMS-related outcomes were included . Data relating to the components of hydrotherapy programs ( exercise type , duration , frequency and intensity , environmental factors , and service delivery ) were analyzed . Results Eleven r and omized controlled trials were included in this review . Overall , the quality of trials was good . Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component . Great variability was noted in both the environmental components of hydrotherapy programs and service delivery . Conclusions Aerobic exercise , warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes . Treatment duration of 60 minutes , frequency of three sessions per week and an intensity equivalent to 60%–80 % maximum heart rate were the most commonly reported exercise components . Exercise appears to be the most important component of an effective hydrotherapy program for FMS , particularly when considering mental health-related outcomes OBJECTIVE To compare 2 exercise modalities , aerobic fitness training and stretching exercises , in patients with fibromyalgia ( FM ) in relation to function , pain , quality of life , depression , and anxiety , and to correlate the cardiorespiratory fitness gain with symptom improvement . METHODS Seventy-six women with FM between 18 and 60 years old were r and omized to either an aerobic program or stretching program , for 20 weeks . They were evaluated at the beginning of the program and after 10 and 20 weeks in relation to the improvement of aerobic fitness , flexibility , function , Fibromyalgia Impact Question naire ( FIQ ) , Short-form Health Survey ( SF-36 ) , and depression and anxiety levels . Ventilatory anaerobic threshold ( VT ) and maximum oxygen uptake ( VO2max ) were determined by expired gas analyses . RESULTS Aerobic exercise was superior to stretching in relation to VO2 max , VT , function , depression , pain , and the emotional aspects and mental health domains of SF-36 . Patients in the stretching group showed no improvement in depression , " role emotional , " and " mental health . " No association was noted between improvement in aerobic fitness as measured by VT and the improvement of pain , function , or scores in FIQ and SF-36 . CONCLUSION Our results confirm that aerobic exercise is beneficial to patients with FM , but the cardiorespiratory fitness gain is not related to improvement of FM symptoms OBJECTIVES To compare the cognitive function performance in patients with fibromyalgia ( FM ) with respect healthy controls and to evaluate the short-term efficacy of exercise therapy in a warm , chest-high pool on pain and cognitive function in women with FM . METHODS Sixty middle-aged women with FM were r and omly assigned to either an exercise training group ( n = 35 ) to perform 3 sessions per week of aquatic training ( 32 degrees C ) including mobility , aerobic , strengthening , and relaxation exercises for 16 weeks , or a control group ( n = 25 ) . Twenty-five healthy women matched for age , weight , body mass index , and educational and physical activity levels were recruited .  Pain was assessed in patients using a syringe calibrated like a pressure dolorimeter , and a visual analog scale . The severity of FM was evaluated using the Fibromyalgia Impact Question naire . Cognitive function was measured in healthy individuals and patients using several st and ardized neuropsychological tests . All patients were measured at baseline and post-treatment . RESULTS At baseline , the healthy group evidence d cognitive performance that was significantly superior to the group of patients with FM in all of the neuropsychological tests . The exercise group significantly improved their pain threshold , tender point count , self-reported pain , severity of FM , and cognitive function , while in the control group the differences were not significant . CONCLUSION An exercise therapy three times per week for 16 weeks in a warm-water pool is an adequate treatment to decrease the pain and severity of FM well as to improve cognitive function in previously unfit women with FM and heightened painful symptomatology BACKGROUND Exercise therapy is an effective component of fibromyalgia ( FM ) treatment . However , it is important to know the effects and specificities of the different types of exercise : muscle stretching and resistance training . AIM To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients . DESIGN R and omized controlled trial . SETTING Physical therapy service , FM outpatient clinic . POPULATION Forty-four women with FM ( 79 screened ) . METHODS Patients were r and omly allocated into a stretching group ( N.=14 ) , resistance group ( N.=16 ) , and control group ( N.=14 ) . Pain was assessed using the visual analog scale , pain threshold using a Fischer dolorimeter , FM symptoms using the Fibromyalgia Impact Question naire ( FIQ ) , and quality of life using the Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36 ) . The three intervention groups continued with usual medical treatment . In addition , the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks . RESULTS After treatment , the stretching group showed the highest SF-36 physical functioning score ( P=0.01 ) and the lowest bodily pain score ( P=0.01 ) . The resistance group had the lowest FIQ depression score ( P=0.02 ) . The control group had the highest score for FIQ morning tiredness and stiffness , and the lowest score for SF-36 vitality . In clinical analyses , the stretching group had significant improvement in quality of life for all SF-36 domains , and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning , vitality , social function , emotional role , and mental health . CONCLUSIONS Muscle stretching exercise was the most effective modality in improving quality of life , especially with regard to physical functioning and pain , and resistance training was the most effective modality in reducing depression . CLINICAL REHABILITATION IMPACT The trial included a control group and two intervention groups , both of which received exercise programs created specifically for patients with FM . In clinical practice , we suggest including both modalities in an exercise therapy program for FM OBJECTIVE To determine the effectiveness of a muscle strengthening program compared to a stretching program in women with fibromyalgia ( FM ) . METHODS Sixty-eight women with FM were r and omly assigned to a 12 week , twice weekly exercise program consisting of either muscle strengthening or stretching . Outcome measures included muscle strength ( main outcome variable ) , flexibility , weight , body fat , tender point count , and disease and symptom severity scales . RESULTS No statistically significant differences between groups were found on independent t tests . Paired t tests revealed twice the number of significant improvements in the strengthening group compared to the stretching group . Effect size scores indicated that the magnitude of change was generally greater in the strengthening group than the stretching group . CONCLUSION Patients with FM can engage in a specially tailored muscle strengthening program and experience an improvement in overall disease activity , without a significant exercise induced flare in pain . Flexibility training alone also results in overall improvements , albeit of a lesser degree Objective Autonomic dysfunction is an important mechanism that could explain many symptoms observed in fibromyalgia ( FM ) .  Exercise is an effective treatment , with benefits potentially mediated through changes in autonomic modulation . Strengthening is one of the less studied exercises in FM , and the acute and chronic effects of strengthening on the autonomic system remain unknown . The objective of this study was to assess the chronic effects of strengthening exercises ( STRE ) on autonomic modulation , pain perception and the quality of life ( QOL ) of FM patients . Methods Eighty sedentary women with FM ( ACR 1990 ) were r and omly selected to participate in STRE or flexibility ( FLEX ) exercises in a blinded controlled trial . The intensity of STRE was set at 45 % of the estimated load of 1 Repetition Maximum ( RM ) in 12 different exercises . Outcomes were Visual Analog Scale ( VAS ) for pain , Heart Rate Variability ( HRV ) analysis , treadmill test , the sit and reach test ( Wells and Dillon ’s Bench ) , maximal repetitions test and h and grip dynamometry ; and quality of life by the Fibromyalgia Impact Question naire ( FIQ ) , the Beck and I date Trait-State Inventory ( I DATE ) , a short-form health survey ( SF-36 ) . Results The STRE group was more effective to strength gain for all muscles and pain control after 4 and 16 weeks ( p<0.05 ) . The FLEX group showed higher improvements in anxiety ( p<0.05 ) . Both groups showed improvements in the QOL , and there was no significant difference observed between the groups . There was no change in the HRV of the STRE and FLEX groups . Conclusions Strengthening exercises show greater and more rapid improvements in pain and strength than flexibility exercises . Despite the benefits in fitness , pain , depression , anxiety and quality of life , no effect was observed on the autonomic modulation in both groups . This observation suggests that changes in autonomic modulation are not a target tobe clinical ly achieved in fibromyalgia . Trial Registration Clinical Trials.gov OBJECTIVE To determine the feasibility of conducting a r and omized controlled trial of a 12-week exercise intervention in children with fibromyalgia ( FM ) and to explore the effectiveness of aerobic exercise on physical fitness , function , pain , FM symptoms , and quality of life ( QOL ) . METHODS FM patients ages 8 - 18 years were r and omized to a 12-week exercise intervention of either aerobics or qigong . Both groups participated in 3 weekly training sessions . Program adherence and safety were monitored at each session . Data were collected at 3 testing sessions , 2 prior to and 1 after the intervention , and included FM symptoms , function , pain , QOL , and fitness measures . RESULTS Thirty patients participated in the trial . Twenty-four patients completed the program ; 4 patients dropped out prior to training and 2 dropped out of the aerobics program . Better adherence was reported in the aerobics group than in the qigong group ( 67 % versus 61 % ) . Significant improvements in physical function , functional capacity , QOL , and fatigue were observed in the aerobics group . Anaerobic function , tender point count , pain , and symptom severity improved similarly in both groups . CONCLUSION It is feasible to conduct an exercise intervention trial in children with FM . Children with FM tolerate moderate-intensity exercise without exacerbation of their disease . Significant improvements in physical function , FM symptoms , QOL , and pain were demonstrated in both exercise groups ; the aerobics group performed better in several measures compared with the qigong group . Future studies may need larger sample sizes to confirm clinical improvement and to detect differences in fitness in childhood FM OBJECTIVE To investigate the effects of supervised aerobic exercise ( AE ) and a combined program of supervised aerobic , muscle strengthening , and flexibility exercises ( combined exercise [ CE ] ) on important health outcomes in women with fibromyalgia syndrome ( FMS ) . DESIGN R and omized controlled trial . SETTING Community-based supervised intervention . PARTICIPANTS Women ( N=64 ) with a diagnosis of FMS according to the American College of Rheumatology criteria . INTERVENTION Participants were r and omly allocated to 1 of 3 groups : supervised AE , supervised CE , or usual-care control . Exercise sessions were performed twice weekly ( 45 - 60min/session ) for 24 weeks . MAIN OUTCOME MEASURES The primary outcome measure was the Fibromyalgia Impact Question naire ( FIQ ) . Exploratory outcome measures were the 36-Item Short-Form Health Survey , Beck Depression Inventory ( BDI ) , aerobic capacity ( 6-minute walk test ) , h and -grip strength , and range of motion in the shoulders and hips . RESULTS Compliance with both interventions was excellent , with women in the exercise groups attending more than 85 % of sessions . A 14 % to 15 % improvement from baseline in total FIQ score was observed in the exercise groups ( P≤.02 ) and was accompanied by decreases in BDI scores of 8.5 ( P<.001 ) and 6.4 ( P<.001 ) points in the AE and CE groups , respectively . Relative to nonexercising controls , CE evoked improvements in the SF-36 Physical Functioning ( P=.003 ) and Bodily Pain ( P=.003 ) domains and was more effective than AE for evoking improvements in the Vitality ( P=.002 ) and Mental Health ( P=.04 ) domains . Greater improvements also were observed in shoulder/hip range of motion and h and grip strength in the CE group . CONCLUSION Given the equivalent time commitment required for AE and CE , our results suggest that women with FMS can gain additional health benefits by engaging in a similar volume of CE OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice OBJECTIVE To determine the safety , feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome ( FMS ) . METHODS Fifteen women with confirmed FMS were monitored for injury and exercise compliance , and assessed for muscle strength ( 1-repetition maximum technique ) , cardiovascular endurance ( 6-minute walk test ) , and functional status ( Fibromyalgia Impact Question naire [ FIQ ] ) before and after a 20-week exercise intervention . RESULTS Zero injuries and an 81 % compliance rate occurred during training . Improvement was seen in muscle strength of the lower ( 191 + /- 75 to 265 + /- 67 pounds ; P < 0.001 ) and upper ( 61 + /- 18 to 76 + /- 18 pounds ; P < 0.001 ) body , 6-minute walk distance ( 530 + /- 80 to 629 + /- 74 meters ; P < 0.001 ) , and in FIQ score ( 44 + /- 9 to 32 + /- 14 ; P < 0.01 ) . CONCLUSION A program of progressive strength training and cardiovascular exercise can be safe , well tolerated , and effective at improving muscle strength , cardiovascular endurance and functional status in women with FMS without exacerbating symptoms . This program may also contribute to a reduction in the severity of several symptoms OBJECTIVE To assess the utility of an exercise program , which included aerobic , flexibility and strengthening elements , in the treatment of fibromyalgia ( FM ) . FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching . It has been suggested that aerobic exercise is helpful in its treatment . METHODS We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities . Measurements performed on each patient at the pre and post study assessment included the number of tender points ( TP ) , total myalgic scores ( TM ) , aerobic fitness ( AF ) , flexibility and isokinetic strength . After initial evaluation patients were r and omly assigned to either an exercise or a relaxation group . Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation . All patients data were stored in a computerized data base and statistical analysis was performed on all pre and post study assessment s. RESULTS Thirty-eight patients ( 18 exercise and 20 relaxation ) completed the study . Analysis of our data showed no significant difference between the groups in their pre study assessment . Post study assessment s , however , showed a significant improvement between the exercise and relaxation groups in TP ( p < 0.05 ) , TM ( p < 0.05 ) , and AF ( p < 0.05 ) . Similar improvements were also found when the pre and post study assessment of the exercise group were compared . CONCLUSION Exercise is helpful in the management of FM in the short term . It also shows that FM patients can undertake an exercise program which includes aerobic , flexibility , and strength training exercises without adverse effects . The long term utility of this type of exercise requires further evaluation OBJECTIVE Abnormalities of the biological stress response ( hypothalamic-pituitary-adrenal axis and the autonomic nervous system ) have been identified in both fibromyalgia ( FM ) and chronic fatigue syndrome ( CFS ) . Although these changes have been considered to be partly responsible for symptom expression , we examine an alternative hypothesis that these HPA and autonomic changes can be found in subsets of healthy individuals in the general population who may be at risk of developing these conditions . Exposure to " stressors " ( e.g. , infections , trauma , etc . ) may lead to symptom expression ( pain , fatigue , and other somatic symptoms ) in part by precipitating lifestyle changes . In particular , we focus on the effect of deprivation of routine aerobic exercise on the development of somatic symptoms . METHODS Eighteen regularly exercising ( > /=4 h/week ) asymptomatic , healthy adults refrained from physical activity for 1 week . We predicted that a subset of these individuals would develop symptoms of FM/CFS with exercise deprivation , and this manuscript focuses on the baseline HPA axis , immune , and autonomic function measures that may predict the development of symptoms . RESULTS Eight of the subjects reported a 10 % increase in one or more symptoms ( pain , fatigue , mood ) after 1 week of exercise deprivation . These symptomatic subjects had lower HPA axis ( baseline cortisol prior to VO2max testing ) , immune ( NK cell responsiveness to venipuncture ) , and autonomic function ( measured by heart rate variability ) at baseline ( prior to cessation of exercise ) when compared to the subjects who did not develop symptoms . CONCLUSIONS A subset of subjects developed symptoms of pain , fatigue , or mood changes after exercise deprivation . This cohort was different from the individuals who did not develop symptoms in baseline measures of HPA axis , immune , and autonomic function . We speculate that a subset of healthy individuals who have hypoactive function of the biological stress response systems unknowingly exercise regularly to augment the function of these systems and thus suppress symptoms . These individuals may be at risk for developing chronic multisymptom illnesses ( CMIs ) ( e.g. , FM or CFS among others ) when a " stressor " leads to lifestyle changes that disrupt regular exercise PURPOSE The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia ( FM ) . DESIGN Cross-sectional descriptive , correlational study of 2,580 persons with FM who responded to an online survey during fall 2005 . METHODS The survey indicated self-reported physical activity levels , functional abilities , symptoms , health care costs , employment status , work productivity , self management strategies . It had adequate validity and reliability . A significant binary logistic regression model of predictors of physical function ( individual factors , symptoms , self management strategies ) was vali date d using backwards logistic regression . FINDINGS Significant explanatory variables of high physical function were : men , greater education , younger age , lower intensity fatigue , spasticity , and balance problems , not using prescription pain medications , using aerobic or strength training exercise , and not using relaxation methods . CONCLUSIONS People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional . Given knowledge of predictors of physical function in FM , health care providers might be able to develop strategies to promote better functioning . Prospect i ve trials are needed to track the natural course of study variables , measuring their effect on function , and to test effects of interventions to maximize function OBJECTIVE Treatment recommendations for fibromyalgia ( FM ) include regular physical exercise . In this prospect i ve study we examined predictors for adherence to stretching and aerobic exercises in women provided with an individualized home based program .  METHODS Thirty-nine women kept exercise diaries for 12 weeks . RESULTS For both types of exercise , women who were less physically fit at baseline engaged in more exercise during the program . Yet for stretching , more lower body pain at baseline predicted engaging in less stretching exercise over time , whereas for aerobic exercise , more baseline upper body pain predicted more exercise over time . As time passed , participants with higher baseline physical fitness and /or older age were reducing their aerobic exercise practice at significantly faster rates , as were those women with higher baseline stress . CONCLUSION Given that adequate levels of adherence were limited to about half of the participants for both types of exercise , steps to reduce barriers to exercise ( e.g. , stress ) need to be taken when prescribing exercise in the treatment of FM & NA ; Both pharmacological and non‐pharmacological interventions have demonstrated efficacy in the management of fibromyalgia ( FM ) .  Non‐pharmacological interventions however are far less likely to be used in clinical setting s , in part due to limited access . This manuscript presents the findings of a r and omized controlled trail of an Internet‐based exercise and behavioral self‐management program for FM design ed for use in the context of a routine clinical care . 118 individuals with FM were r and omly assigned to either ( a ) st and ard care or ( b ) st and ard care plus access to a Web‐Enhanced Behavioral Self‐Management program ( WEB‐SM ) grounded in cognitive and behavioral pain management principles . Individuals were assessed at baseline and again at 6 months for primary endpoints : reduction of pain and an improvement in physical functioning . Secondary outcomes included fatigue , sleep , anxiety and depressive symptoms , and a patient global impression of improvement . Individuals assigned to the WEB‐SM condition reported significantly greater improvement in pain , physical functioning , and overall global improvement . Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period . A no‐contact , Internet‐based , self‐management intervention demonstrated efficacy on key outcomes for FM . While not everyone is expected to benefit from this approach , this study demonstrated that non‐pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes BACKGROUND Self-management has increasingly been recommended as part of st and ard care for fibromyalgia , a common , poorly understood condition with limited treatment options . Data that assess popular self-management recommendations are scarce . We evaluated and compared the effectiveness of 4 common self-management treatments on function , symptoms , and self-efficacy in women with fibromyalgia . METHODS A total of 207 women with confirmed fibromyalgia were recruited from September 16 , 2002 , through November 30 , 2004 , and r and omly assigned to 16 weeks of ( 1 ) aerobic and flexibility exercise ( AE ) ; ( 2 ) strength training , aerobic , and flexibility exercise ( ST ) ; ( 3 ) the Fibromyalgia Self-Help Course ( FSHC ) ; or ( 4 ) a combination of ST and FSHC ( ST-FSHC ) . The primary outcome was change in physical function from baseline to completion of the intervention . Secondary outcomes included social and emotional function , symptoms , and self-efficacy . RESULTS Improvements in the mean Fibromyalgia Impact Question naire score in the 4 groups were -12.7 for the ST-FSHC group , -8.2 for the AE group , -6.6 for the ST group , and -0.3 for the FSHC group . The ST-FSHC group demonstrated greater improvement than the FSHC group ( mean difference , -12.4 ; 95 % confidence interval [ CI ] , -23.1 to -1.7 ) . The ST-FSHC ( mean difference , 13.6 ; 95 % CI , 2.3 to 24.9 ) and AE ( mean difference , 13.1 ; 95 % CI , 1.6 to 25.6 ) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey . Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC ( 14.8 ) , AE ( 13.2 ) , and ST ( 5.7 ) groups . Social function , mental health , fatigue , depression , and self-efficacy also improved . The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months . CONCLUSIONS Progressive walking , simple strength training movements , and stretching activities improve functional status , key symptoms , and self-efficacy in women with fibromyalgia actively being treated with medication . The benefits of exercise are enhanced when combined with targeted self-management education . Our findings suggest that appropriate exercise and patient education be included in the treatment of fibromyalgia Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made OBJECTIVE The aim of this study was to evaluate the cardiorespiratory fitness and perceived exertion of female patients with fibromyalgia syndrome ( FMS ) compared with that of healthy female subjects . DESIGN AND SUBJECTS This was design ed as a cross-sectional case-control study , with a consecutive sample of 30 female patients with FMS and an age-matched control group of 67 healthy female subjects . SETTING This study was conducted at the multidisciplinary pain center of a university hospital in a city of more than 1 million inhabitants . OUTCOME MEASURES A cardiorespiratory fitness index ( PWC65%/kg ) and an original perceived exertion index ( B65 % ) were obtained from the  heart rates and perceived exertions scored on a 10-point Borg scale during a submaximal cycle ergometer test .  Average indexes for the FMS patients and control subjects were compared . RESULTS The mean cardiorespiratory fitness index of the FMS patients was not significantly different from that of the controls . The mean perceived exertion index in the FMS patients was significantly greater than that of the controls , meaning that the FMS patients systematic ally reported higher ratings of perceived exertion during exercise . CONCLUSIONS Cardiorespiratory fitness , as expressed by a submaximal work capacity index , seems normal in female patients with FMS compared with age- and sex-matched healthy individuals . The fact that FMS patients overscore their perception of exertion may be due to a greater overlap of peripheral pain and perceived exertion perceptions during exercise . This observation should be noted when using perceived exertion scores to prescribe and monitor exercise in FMS patients Abstract : Fibromyalgia ( FM ) is a disorder characterised by diffuse widespread musculoskeletal aching and stiffness and multiple tender points [ 1 ] . Its pathophysiology is poorly understood . The influence of aerobic endurance exercise on pain in patients with FM was investigated . Twenty-seven patients ( 25 female , 2 male ) participated in a controlled clinical study and performed 12 weeks of jogging , walking , cycling or swimming following a given schedule .  Twelve sedentary FM patients ( 11 female , 1 male ) served as controls . Before and after training both the study and the control groups were evaluated spiroergometrically .  Tender point pain was quantified by dolorimetry . The painful body surface was estimated by a pain body diagram , and its intensity by a visual analogue scale and a ranking scale . Patients trained for an average of 25 min two to three times a week , with an average intensity of 50 % of maximal oxygen uptake ( VO2max ) . Unlike the control group , the training group exhibited a decrease in heart rate and VO2 and an increase in respiratory quotient during submaximal workload . Maximal performance capacity and VO2max remained unchanged , whereas the wattpulse ( watt/heart rate ) improved at maximal workload . Pain parameters remained unchanged in the control group , but in the training group the mean number of positive tender points ( 15.4/12.7 ) , the mean pain threshold of the gluteal tender point ( 2.89 kp/3.50 kp ) and the painful body surface ( 18%/15 % body surface ) decreased significantly . Subjective general pain condition deteriorated in two patients but improved in 17 . Our results suggest a positive effect of aerobic endurance exercise on fitness and well-being in patients with FM This article describes an ongoing , long-term clinical exercise program for women with fibromyalgia syndrome ( FMS ) , some of whom also have chronic fatigue and immune dysfunction syndrome ( CFIDS ) . The recorded outcomes from the most recent year of the program also are reported . Participants engaged in sessions lasting 50 - 70 minutes , 5 days per week ; each session involved aerobic activity , resistance training , and other dynamic exercise . One group was in the program for 3 years and another group was in the program for 2 years . Program outcomes for the year ( comparing beginning and end-of-year results ) are presented for both groups on physical fitness , psychosocial , and FMS/CFIDS symptoms . The outcomes support that all of the women appear to have benefited from the program in numerous ways , suggesting that the program works . Also , those outcomes are in agreement with past research reported in this journal . Implication s for clinical nurse specialists working with FMS/CFIDS patients are discussed This study was aim ed to investigate the effects of an exercise trial on self-esteem , self-concept and quality of life in patients with fibromyalgia and to evaluate whether improvements in psychological distress were related to changes in physical functioning . Twenty-eight women with a primary diagnosis of fibromyalgia were r and omized to a usual care control group or to a 12-week supervised training programme consisting of 3 weekly sessions of aerobic , strengthening and flexibility exercises . Outcomes were physical functioning ( Fibromyalgia Impact Question naire ( FIQ ) , lower-body strength and flexibility ) and psychological functioning ( SF-36 , Rosenberg self-esteem scale and Erdmann self-concept scale ) . Outcomes were measured at study entry and at the end of the intervention . Compared to the control group , statistically significant improvements in self-esteem , self-concept , FIQ , physical functioning , role physical , bodily pain , vitality , role emotional , social functioning , mental health , isometric strength , muscular endurance and flexibility were evident in the exercise group at the end of treatment . Self-esteem and self-concept scores were correlated positively with role emotional , mental health and the mental component summary of SF-36 and were negatively correlated to FIQ scores . No significant correlation existed between self-esteem or self-concept and isometric strength , muscular endurance or flexibility . Our results highlight the need for a broader array of physical and mental outcomes and the importance of examining patient ’s perceptions in future research therapies BACKGROUND AND PURPOSE The purpose s of this study were : ( 1 ) to assess the effectiveness of a 16-week progressive program of home-based , videotape-based , low-impact aerobic exercise on physical function and signs and symptoms of fibromyalgia in previously sedentary women aged 20 to 55 years and ( 2 ) to compare the effects of 1 long exercise bout versus 2 short exercise bouts per training day ( fractionation ) on physical function , signs and symptoms of fibromyalgia , and exercise adherence . SUBJECTS One hundred forty-three sedentary women were r and omly assigned to 1 of 3 groups : a group who trained using a long bout of exercise ( LBE group , n=51 ) , a group who trained using short bouts of exercise ( SBE group , n=56 ) , and a group who performed no exercise ( NE group , n=36 ) . METHODS The SBE group exercised twice daily , and the LBE group worked out once daily . Both groups progressed in total daily training duration from 10 to 30 minutes , 3 to 5 times a week , for 16 weeks . Physical and psychological well-being , symptoms , and self-efficacy were evaluated using a multivariate analysis of variance . RESULTS Dropout rates for the NE , SBE , and LBE groups were 14 % , 38 % , and 29 % , respectively . The NE group differed from the LBE group in disease severity , self-efficacy , and psychological well-being ( midtest , efficacy analysis ) and from the SBE group in disease severity and self-efficacy ( posttest , efficacy analysis ) . Exercise adherence was greater for the LBE group than for the SBE group between weeks 5 and 8 of the training program . No other differences between exercise groups were found . DISCUSSION AND CONCLUSION Progressive , home-based , low-impact aerobics improved physical function and fibromyalgia symptoms minimally in participants who completed at least two thirds of the recommended exercise . Fractionation of exercise training provided no advantage in terms of exercise adherence , improvements in fibromyalgia symptoms or physical function . High attrition rates and problems with exercise adherence were experienced in both exercise groups Background Knee osteoarthritis ( OA ) is a prevalent chronic musculoskeletal condition with no cure . Pain is the primary symptom and results from a complex interaction between structural changes , physical impairments and psychological factors . Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population . There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training ( PCST ) particularly in other chronic pain conditions . Though typically provided separately , there are symptom , re source and personnel advantages of exercise and PCST being delivered together by a single healthcare professional . Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management . No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population . The primary aim of this multisite r and omised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA . Methods / design This will be an assessor-blinded , 3-arm r and omised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice . Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and r and omized into one of three groups : exercise alone , PCST alone , or integrated PCST and exercise .  R and omisation will be stratified by city ( Melbourne or Brisbane ) and gender . Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale . Secondary outcomes include global rating of change , muscle strength , functional performance , physical activity levels , health related quality of life and psychological factors . Measurements will be taken at baseline and immediately following the intervention ( 12 weeks ) as well as at 32 weeks and 52 weeks to examine maintenance of any intervention effects . Specific assessment of adherence to the treatment program will also be made at weeks 22 and 42 . Relative cost-effectiveness will be determined from health service usage and outcome data . Discussion The findings from this r and omised controlled trial will provide evidence for the efficacy of an integrated PCST and exercise program delivered by physiotherapists in the management of painful and functionally limiting knee OA compared to either program alone . Trial registration Australian New Zeal and Clinical Trials Registry reference number :
There is ' gold ' level evidence ( www.cochranemsk.org ) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms .
Strength training may also have benefits on some FMS symptoms .
BACKGROUND Fibromyalgia ( FMS ) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services .
Exercise training is commonly recommended as a treatment .
This is an up date of a review published in Issue 2 , 2002 .
OBJECTIVES The primary objective of this systematic review was to evaluate the effects of exercise training including cardiorespiratory ( aerobic ) , muscle strengthening , and /or flexibility exercise on global well-being , selected signs and symptoms , and physical function in individuals with FMS .