Journal Article Review January 2016

January, 2016:  How can you help patients suffering from fibromyalgia?

To continue reading from Report on Hands, scroll down to RESULTS

Larsson A et al: Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia–a randomized controlled trial. Arthritis Res Ther. 2015 Jun 18;17:161

Although the cause of fibromyalgia (FM) remains a mystery, the general consensus is that normal sensory input to the brain is erroneously amplified along with impairment of pain inhibition. Physical deconditioning may contribute to the development of FM, so a strengthening regimen might help.

Swedish investigators recruited 130 women who met rigid inclusion/exclusion criteria and divided them randomly into two groups. One group performed twice-weekly, supervised strengthening exercises. The other group participated in supervised relaxation therapy.

Outcome measures, obtained pre-study and after 15 weeks of treatment included quadriceps, biceps, and grip strengths and questionnaires on general health, chronic pain acceptance, fear avoidance, and global impression of change.

An experienced physical therapist supervised both types of intervention. The resistance exercise program took into account each participant’s thoughts and past experience with exercise and tailored individualized, graded strengthening programs modified weekly according to progress and confidence.

Seventy percent of participants then completed the outcomes questionnaires 13-18 months following treatment.

RESULTS:  After 15 weeks, the exercise group showed….

significant improvement in quadriceps and biceps strength but not in grip strength compared to the relaxation therapy control group. The exercise group also showed significant improvements in the general health outcomes questionnaire, pain disability index, chronic pain acceptance, and global impression of change. The groups did not differ with respect to fear avoidance.

Also, the exercise group increased their level of moderate to vigorous physical activity significantly compared to the relaxation group.

At 13-18 month follow-up, no differences were noted between the groups regarding the outcomes measures, and both groups had increased their time of moderate to vigorous physical activity equally.

DISCUSSION: The authors speculate that the benefits of resistance exercise were not lasting because of a failure of the participants to continue exercising on their own. Likely causes were a lack of motivation, supervision, time, gym membership, or priority.

The authors conclude that a supervised resistance program where the loads and progression are individually adjusted according to each participant’s ability and comfort proved beneficial. Since the beneficial effects declined to baseline levels following completion of the study, they recommend that long-term guidance and support be provided to increase the habituation of regular exercise.

COMMENT:  I stop and look closely at any article that has randomized and controlled in the title. This is a carefully constructed and well-performed study that has practical advice and attainable goals for treatment of fibromyalgia.  The other word I like to see in titles is blinded, but of course in this study, blinding the participants and investigators to relaxation vs. resistance exercise was not possible.

The authors wisely had their control group do something so that the frequency and duration of interaction with a skilled therapist was equal for both groups. The complete article is available without charge. Have a look.  PDF