Efficacy of Physical Exercise Therapy as a Treatment for Fibromyalgia Patients An Evaluation of the Evidence

Abstract

Background: Fibromyalgia (FM) is a chronic pain disorder characterized by widespread pain. Recent hypotheses regarding the pathogenesis of FM has primarily focused upon the concept of central sensitization (CS). The musculoskeletal system has been suggested to act as a potential source of pain contributing to CS, suggesting that in theory physical therapy, including manual therapy, may be useful in treating some of the pain associated with FM. Presently, no known cure exists for FM, and current primary care management may include a mixture of pharmacological treatments, as well as manual and physical therapy, including the use of aerobic and strengthening exercises. Objective: As manual and physical therapy are often conducted in conjunction with prescribed exercises, this article examines evidence in regard to the efficacy of employing physical exercise therapy within a manual/physical therapy clinical setting as a potential intervention for patients with FM. Methods: Databases and reference sections of original studies and systematic reviews on physical exercise therapy in FM were reviewed (for relevant literature from 2009 to 2014). The author was solely responsible for the selection of studies for inclusion based on defined inclusion and exclusion criteria. Following critical appraisal using The Critical Skills Appraisal Program (CASP), evidence ratings were applied to the studies using The Oxford Rating Scale developed by the Centre for Evidence-Based Medicine (CEBM) and The Scottish Intercollegiate Guidelines Network (SIGN) checklist. Results: The studies reviewed suggested that physical exercise therapy, including aerobic exercise (AE) and strength training, could benefit FM patients in terms of pain amelioration and improvement of range of motion (ROM), improving health-related quality of life (HQoL) by improving sleep patterns and reducing medication usage, as well as reducing depression and improving psychological wellbeing. Conclusion: There is evidence to support the use of physical exercise therapy as a therapy for FM sufferers. However, there remains a lack of certainty regarding the most efficacious exercise intervention, mainly due to the methodological constraints affecting the available studies, as well as the heterogeneity and lack of standardization with regard to available exercise-based treatment programmes for FM sufferers, which makes the act of comparing the studies available challenging. KeywordsFibromyalgia; Fibromyalgia Syndrome; Physical Therapy; Physiotherapy; Exercise Therapy; Physical Exercise Therapy