Abstract
IntroductionFibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Muscle strength in women with FM is reduced compared to healthy women. The aim of this study was to examine the effects of a progressive resistance exercise program on muscle strength, health status, and current pain intensity in women with FM.MethodsA total of 130 women with FM (age 22–64 years, symptom duration 0–35 years) were included in this assessor-blinded randomized controlled multi-center trial examining the effects of progressive resistance group exercise compared with an active control group. A person-centred model of exercise was used to support the participants’ self-confidence for management of exercise because of known risks of activity-induced pain in FM. The intervention was performed twice a week for 15 weeks and was supervised by experienced physiotherapists. Primary outcome measure was isometric knee-extension force (Steve Strong®), secondary outcome measures were health status (FIQ total score), current pain intensity (VAS), 6MWT, isometric elbow-flexion force, hand-grip force, health related quality of life, pain disability, pain acceptance, fear avoidance beliefs, and patient global impression of change (PGIC). Outcomes were assessed at baseline and immediately after the intervention. Long-term follow up comprised the self-reported questionnaires only and was conducted after 13–18 months. Between-group and within-group differences were calculated using non-parametric statistics.ResultsSignificant improvements were found for isometric knee-extension force (p = 0.010), health status (p = 0.038), current pain intensity (p = 0.033), 6MWT (p = 0.003), isometric elbow flexion force (p = 0.02), pain disability (p = 0.005), and pain acceptance (p = 0.043) in the resistance exercise group (n = 56) when compared to the control group (n = 49). PGIC differed significantly (p = 0.001) in favor of the resistance exercise group at post-treatment examinations. No significant differences between the resistance exercise group and the active control group were found regarding change in self-reported questionnaires from baseline to 13–18 months.ConclusionsPerson-centered progressive resistance exercise was found to be a feasible mode of exercise for women with FM, improving muscle strength, health status, and current pain intensity when assessed immediately after the intervention.Trial registrationClinicalTrials.gov identification number: NCT01226784, Oct 21, 2010.
Highlights
Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness
The aim of this study was to examine the effects of a progressive resistance exercise program using a personcentered approach, on muscle strength, health status, and current pain intensity in women with FM
Intention-to-treat analysis All participants were invited to a post-treatment examination according to the intent-to-treat design and 81 % of the total sample completed the test, 56 (84 %) belonging to the resistance exercise group and 49 (76 %) in the active control group (Fig. 1)
Summary
Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. No differences in neuromuscular coordination was found in a study comparing exercising women with FM to sedentary controls, and both groups improved their motor unit activity during a resistance exercise program [21] This indicates that a reason for reduced muscle strength in FM might be a low amount of physical activity at such a level that is required to maintain or improve muscle strength. Muscle deconditioning is known to increase the susceptibility to microtrauma related to mechanical strain during physical activities [28], few studies have evaluated the effects of resistance exercise designed to improve muscle strength in FM [15]. Meta-analyses in a Cochrane report of resistance exercise are based on one to three trials [15], warranting further research to improve confidence for estimated effects of resistance exercise for patients with FM [15]
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