FRI0709-HPR EFFECTS OF LAND- AND WATER-BASED EXERCISE INTERVENTIONS ON PAIN IN PEOPLE WITH FIBROMYALGIA: A PRELIMINARY REPORT FROM THE AL-áNDALUS RANDOMISED CONTROLLED TRIAL
Authors: Fernando Estevez-Lopez, Inmaculada C. Alvarez-Gallardo, Víctor Segura-Jiménez, Milkana Borges Cosic, Pedro Acosta-Manzano, Blanca Gavilán Carrera, Ana Carbonell-Baeza, Manuel Delgado-Fernández, Virginia A. Aparicio
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Non-pharmacological approaches are the mainstay of treatment in fibromyalgia. The current recommendations of the European League Against Rheumatism (EULAR) for the management of fibromyalgia highlight that exercise is the only therapy with a 'strong' evidence [1]. Exercise has been typically implemented on either land- or water-based settings. However, it is unclear whether to perform exercise in different settings has different effects on pain; this knowledge might help to maximise the beneficial effects that exercise has in fibromyalgia [2] <h3>Objectives</h3> To compare the effects of two exercise interventions (land- and water-based training) on pain in people with fibromyalgia. <h3>Methods</h3> From 272 initially randomized, a total of 151 participants (50.6±7.6 years old, 98% women) completed all the assessments and attended to at least 70% of the programme; 48, 42 and 61 participants pertained to the land-based exercise, water-based exercise, and usual care (control) groups, respectively. The intervention groups trained 3 non-consecutive days/week (45-60 minutes per session) for 24 weeks. Each session included aerobic exercises, muscular strengthening and stretching for all the major muscle groups. Pain was measured by the 0-100 mm visual analogue scale (VAS) from the Fibromyalgia Impact Questionnaire (FIQ). Catastrophizing and self-efficacy pain-related cognitions were assessed by the Pain Catastrophizing Scale (PCS total score) and pain management subscale (PSE) of the Chronic Pain Self-efficacy Scale (CPSS), respectively. We calculated an algometer score based on the sum of pain thresholds (kg/cm2) of the 18 tender pints according to the 1990 American College of Rheumatology fibromyalgia diagnostic criteria. Participants were evaluated at baseline (pre-test), at the end of the 24-week intervention (post-test) and after a 12-week detraining period (re-test). The groups were comparable in sociodemographic and clinical characteristics; they only differ on age, which was included as a covariate along with baseline levels of pain. <h3>Results</h3> Adjusting for Bonferroni, most of the between-group comparisons of pain changes over time were not significant. As exceptions, in comparison to the control group, participants in the land-based exercise group lowered catastrophizing and improved algometer score at the post-tests; mean difference (95% interval confidence) [MD(95% CI)] = -4.0 (-7.5 to -0.5) and 6.2 (2.0 to 10.5), respectively. These differences became non-significant at the re-test. <h3>Conclusion</h3> These preliminary results suggest that a 24-week land-based exercise intervention had beneficial effects by reducing pain catastrophizing and increasing algometer score in people with fibromyalgia. However, these benefits were unsustained after the detraining period. In compassion to the control group, a water-based exercise intervention did not show any effect on pain. Although our finding suggest that a land-based exercise intervention may have short-term beneficial effects on pain, these findings must be considered as preliminary until more robust analyses are performed. <h3>References</h3> [1] Macfarlane GJ, et al. Ann Rheum Dis2017;76:318–28. Doi:10.1136/annrheumdis-2016-209724 [2] Carbonell-Baeza A, et al. BMC Musculoskelet Disord2012;13:18. Doi:10.1186/1471-2474-13-18 <h3>Acknowledgement</h3> This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R; BES-2014-067612) and the Spanish Ministry of Education (FPU14/02518; FPU 15/00002) <h3>Disclosure of Interests</h3> None declared