|A New Approach to Fibromyalgia
The treatment of fibromyalgia is, for the most part, unsatisfactory. Maybe that's why sufferers often have a considerable degree of anxiety and depression. And while it's known that exercise has proven helpful in some studies in reducing tender-point pain, it's general effect on the poor mood in fibromyalgia subjects has been questionable. Now a Canadian study has been reported in Arthritis Care & Research that provides more conclusive results.
What was done
People with fibromyalgia were recruited by advertisements. They had to meet accepted criteria for the condition, namely widespread pain in combination with tenderness at 11 or more of 18 specific tender point sites.  They also had to be healthy enough to undertake a regular exercise program, and be willing to try to stick to any prescribed anxiety or depression medications they were already taking.
Participants were randomly assigned to go through a supervised exercise program, or to be part of the control group, which didn't undertake any special physical activities. A series of tests was done at the start of the study (baseline), 6 weeks, 12 weeks, and 23 weeks (the end of the study).
The exercise group had 3 hospital-based exercise classes a week, for 23 weeks. Each class consisted of a 5-minute warm-up stretch, a 20-minute aerobic exercise (walking or water-aerobics), and a 5-minulte cool-down stretch. The target heart rates was calculated for each person (210 minus age in years), and aerobic exercising was gradually increased until the subject reach 60% to 75% of their target rate. (Subjects were taught how to measure their own heart rates.)
The main test for depressive symptoms was the Beck Depression Inventory, or BDI, which is a 21-question survey, with scores ranging from 0 to 63; a higher score indicates greater depression. To test physical function, or overall physical ability, the 6-minute walk test was used; subjects were asked to walk at a fast, comfortable pace between two posts set 20 meters apart (about 65 feet), and the distance covered in 6 minute was measured.
Other tests done included counting the number of tender points, and the Fibromyalgia Impact Questionnaire, or FIQ.
There were quite a few people who didn't stick with the program properly, so the investigators decided to do two sets of analyses. The first was of those who fulfilled the required conditions -- they hadn't changed their medications, they'd attended over 45% of the exercise classes, and they completed the 23-week tests.
The second set consisted of all those people who had enrolled and who were tested at the end of the study; this was called the 'Intent-To-Treat' analysis. Some experts think this sort of analysis bears a closer resemblance to real-life conditions, and is therefore more useful, overall, in evaluating a treatment option.
The results of the study
Fifty participants returned for the final tests at 23 weeks -- 27 exercisers and 23 controls -- and constituted the Intent-To-Treat set. Of these, only 31 qualified for the planned efficacy analysis (15 exercisers and 16 controls).
The average age was 47; there were 44 women and 6 men. They had had symptoms for an average of 9 years, with an average of 3½ years since their diagnosis of fibromyalgia.
Here are the results for those who qualified for the planned effectiveness analysis:
The average depression scores on the BDI were 20.1 at baseline in both controls and exercisers. After 23 weeks, the control scores were 19.4, while the exercisers had decreased to an average of 13.6 -- a significant drop.
The 6-minute walk test showed that controls walked 420 meters at baseline and 409 meters after 23 weeks (460 and 440 yards, respectively). The exercisers went from 414 meters at baseline to 489 meters after 23 weeks (453 to 534 yards, respectively); this, also, was a significant change.
The FIQ showed no significant changes over the study in the controls, but the exercisers' scores were significantly decreased (improved) at 23 weeks.
The Intent-To-Treat analysis results:
When all the participants were analyzed, whether they had completed the exercise program properly, or changed their medications or not, they extent of the average changes was lessened, as might be expected. Nevertheless, similar significantly favorable effects of exercise were seen in the BDI, the 6-minute walk test, and the FIQ.
Other tests used also showed significant favorable effects of exercise. However, the number of tender points showed no change in either group in this study.
This study provides evidence that regular, energetic aerobic exercise can help lift the mood and improve physical performance in people with longstanding fibromyalgia. Depression, and sometimes anxiety, is a common accompaniment of fibromyalgia, and many sufferers may prefer to increase their physical activity if there's a chance of reducing it. Certainly this can offer an alternative to medication in many cases.
It's important to note that quite a long period (almost 6 months) was needed to show these good results. Anyone choosing to embark on this sort of program should do so under the supervision of a trained health professional, with appropriate monitoring scheduled to ensure proper performance. A recent publication in the same journal (the full reference is not yet available) suggests that strength (anaerobic) exercise can also have beneficial effects in fibromyalgia.
* Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. SE. Gowans, A. deHueck, S. Voss, et al., Arthritis Care Res, 2001, vol. 45, pp. 519--529
 The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. F. Wolfe, HA. Smythe, MB. Yunus, et.al., Arthritis Rheum , 1990 Feb, vol. 33(2), pp. 160--172
(c) 2002 Novartis Foundation
Source: Health and Age
Date: April 12, 2002
Author: Robert W. Griffith, MD
National Fibromyalgia Partnership, Inc.