Hydrotherapy improves pain, knee strength, and quality of life in women with fibromyalgia

Abstract

For women with fibromyalgia, does a hydrotherapy exercise program produce improvements in muscle strength, quality of life, and pain? Randomised controlled trial. Participants were recruited from a fibromyalgia association in Spain. Women with fibromyalgia confirmed according to American College of Rheumatology criteria. Women who attended other psychological or physical therapies, who exercised regularly, who were pregnant, or who had significant co-morbidities were excluded. Nine eligible patients refused to participate. The remaining 35 were randomised to hydrotherapy (n = 18) or a control group (n = 17). The hydrotherapy group trained in waist-high warm water, three times per week for 12 weeks. Each one-hour session included slow walking and mobility exercises, aerobic exercise at 65–75% of maximal heart rate, and overall mobility and lower-limb strength exercises. At the end of the 12-week training period, the group was instructed to avoid physical exercise training until their next evaluation. The control group was instructed to follow normal daily activities, which did not include any form of regular physical exercise. Maximal torque of the knee flexors and extensors was recorded with an isokinetic dynamometer during fast and slow concentric and slow eccentric contractions. Maximal torque of the shoulder abductors and adductors was recorded during slow concentric contractions. Quality of life was assessed using the overall EuroQol-5D score and its five domains: mobility, self care, daily activities, pain, and anxiety/depression. Subjects also reported a visual analogue score (VAS) from 0 (no pain) to 100 (worst possible pain). All outcomes were assessed at baseline, immediately after the 12-week training period, and 12 weeks later. In the hydrotherapy group, slow concentric knee extensor torque improved significantly more than in the control group, by 0.2 Nm/kg (95% CI 0.15 to 0.25). Similarly, slow concentric knee flexor torque improved significantly more than in the control group, by 0.1 Nm/kg (95% CI 0.05 to 0.15). No other muscle torques differed significantly between groups. Improvement in overall quality of life was significantly greater in the hydrotherapy group, by 29% (95% CI 24 to 34). All subdomains also showed significant benefits due to hydrotherapy, except daily activities. Improvement in the pain VAS was significantly better in the hydrotherapy group, by 19 mm (95% CI 15 to 23). Most of these betweengroup differences were no longer significant 12 weeks later, apart from the self care and anxiety/depression domains. For women with fibromyalgia, a 12-week hydrotherapy exercise program improves knee strength, quality of life, and pain, although few of these changes are maintained 12 weeks later.