Exercise for treating fibromyalgia syndrome
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 17 OCT 2007
Assessed as up-to-date: 16 AUG 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Busch AJ, Barber KA, Overend TJ, Peloso PMJ, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003786. DOI: 10.1002/14651858.CD003786.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 17 OCT 2007
Fibromyalgia (FM) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. This is an update of a review published in Issue 2, 2002.
The primary objective of this systematic review was to evaluate the effects of exercise training including cardiorespiratory (aerobic), muscle strengthening, and/or flexibility exercise on global well-being, selected signs and symptoms, and physical function in individuals with FM.
We searched MEDLINE, EMBASE, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials (CENTRAL, Issue 3, 2005) up to and including July 2005. We also reviewed reference lists from reviews and meta-analyses of treatment studies.
Randomized trials that were selected focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FM.
Data collection and analysis
Two of four reviewers independently extracted data for each study. All discrepancies were rechecked and consensus was achieved by discussion. Methodological quality was assessed by two instruments: the van Tulder and the Jadad methodological quality criteria. We used the American College of Sport Medicine (ACSM) guidelines to evaluate whether interventions had provided a training stimulus that would effect changes in physical fitness. Due to significant clinical heterogeneity among the studies we were only able to meta-analyze six aerobic-only studies and two strength-only studies.
There were a total of 2276 subjects across the 34 included studies; 1264 subjects were assigned to exercise interventions. The 34 studies comprised 47 interventions that included exercise. Effects of several disparate interventions on global well-being, selected FM signs and symptoms, and physical function in individuals with FM were summarized using standardized mean differences (SMD). There is moderate quality evidence that aerobic-only exercise training at recommended intensity levels has positive effects global well-being (SMD 0.49, 95% CI: 0.23 to 0.75) and physical function (SMD 0.66, 95% CI: 0.41 to 0.92) and possibly on pain (SMD 0.65, 95% CI: -0.09 to 1.39) and tender points (SMD 0.23, 95% CI: -0.18 to 0.65). Strength and flexibility remain under-evaluated.
There is 'gold' level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FM symptoms. Strength training may also have benefits on some FM symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FM is needed.
Plain language summary
Exercise for fibromyalgia
This summary of a Cochrane review presents what we know from research about the effect of exercise for fibromyalgia. The review shows that in people with fibromyalgia:
- moderate intensity aerobic training for 12 weeks may improve overall well-being and physical function; moderate intensity aerobic exercise probably leads to little or no difference in pain or tender points.
- strength training for 12 weeks may result in large reductions in pain, tender points and depression, and large improvement in overall well-being but may not lead to any difference in physical function.
- the exercise programs that were studied were safe for most. The intensity of aerobic exercise training should be increased slowly aiming for a moderate level. If exercisers experience increased symptoms, they should cut back until symptoms improve. If in doubt about adverse effects, they should check with a health care professional.
- it is not known whether exercise training for more than 12 weeks improves other symptoms such as fatigue, stiffness or poor sleep. Many people with FM do have difficulty staying on an exercise program. Strategies to help individuals exercise regularly were not measured in these studies.
- it is not known whether flexibility training, programs combining types of exercise, and programs combining exercise with non-exercise strategies improve the symptoms of fibromyalgia.
What is fibromyalgia and what are the different types of exercise?
Fibromyalgia is a syndrome of persistent widespread pain and tenderness. Individuals may also experience a wide range of other symptoms such as difficulty sleeping, fatigue, stiffness, and depression. Symptoms may put people off exercising but studies show that the majority are able to exercise. Exercise training can include aerobics such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretching for flexibility. Although exercise is part of the overall management of fibromyalgia, this review examined the effects of exercise when used separately or combined with other strategies such as education programs, biofeedback and medications.
Best estimate of what happens to people with fibromyalgia who take part in aerobic exercise:
In the studies, aerobic exercises were done for at least 20 minutes once a day (or twice for at least 10 minutes), 2 to 3 days a week. Strength training was done 2 to 3 times a week and with at least 8 to 12 repetitions per exercise. The exercise programs lasted between 2 ½ to 24 weeks.
When compared to no exercising, aerobic exercise training may:
- improve overall well-being by 7 points on a scale of 0 to 100.
- improve ability to perform aerobic exercise; by using 2.8 ml/kg/minute more oxygen when walking on a treadmill.
- increase the amount of pressure that can be applied to a tender point by 0.23 kgs/cm
- reduce pain by 1.3 on a scale of 0 to 10.
- have unknown effects on fatigue, depression or stiffness.
These results are based on moderate quality evidence.
Best estimate of what happens to people with fibromyalgia who take part in strength training:
When compared to no exercise, strength training may:
- reduce pain by 49 fewer points on scale of 0 to 100.
- improve overall well-being by 41 points on a scale of 0 to 100.
- lead to 2 fewer active tender points on a scale of 0-18.
These results are based on low quality evidence.
The numbers given are our best estimate. When possible, we have also presented a range because there is a 95 percent chance that the true effect of the treatment lies somewhere within that range.
本研究搜尋範圍為2005年7月前有控制組實驗的文獻，搜尋資料庫包含有MEDLINE, EMBASE, CINAHL, SportDiscus, PubMed, PEDro, 和Cochrane Central Register， 同時回顧整合分析文獻當中的參考文獻資料。
總共34篇研究2276位參與者；1264位參與者被分派到運動介入，34篇研究包括47種介入方式，當中包含運動介入。不同介入對於纖維肌痛症候群患者整體安適感、病徵和症狀及身體功能的影響將使用標準平均差作為總結結論。在中等級證據力的結果指出，建議強度下的有氧運動的訓練 對於整體安適感(SMD 0.44, 95% CI 0.13 to 0.75)、身體功能(SMD 0.68, 95% CI 0.41 to 0.95) 、可能的疼痛(SMD 0.94, 95% CI −0.15 to 2.03)以及壓痛點(SMD 0.26, 95% CI −0.28 to 0.79)都有正面的影響。肌力和柔軟度則需進一步的分析評估。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
本次Cochrane醫學文獻資料庫對於纖維肌痛症候群患者運動治療的文獻回顧結果顯示，纖維肌痛症候群的患者進行12週中等強度的有氧運動可以些微的增進整體的安適感以及身體功能，而中等強度的有氧運動對於疼痛或壓痛點的改善幅度相當小或是沒有顯著的改變；而12週的肌力訓練可以大幅的減少疼痛、壓痛點、沮喪以及增加整體的安適感，但是對於身體功能並未有顯著的影響。 運動計畫的安全性是相當重要的一環，有氧運動的強度必須以緩慢的速度增加至中等強度，運動者如果感受到症狀持續惡化，則必須降低運動強度直到症狀改善，然而目前還不知道超過12週的訓練是否可以進一步改善患者一些疲勞、僵硬、睡眠品質不良的症狀。許多纖維肌痛患者很難維持規律性的運動計畫，但本研究並未著重於如何幫助患者達成規律性的運動，而關於柔軟度訓練、結合各種不同運動的計畫，合併運動及非運動的方法是否能夠改善纖維肌痛的症狀也尚未明朗。 什麼是纖維肌痛症？而什麼又是不同形式的運動？纖維肌痛症的症狀廣泛性的疼痛感和壓痛感，此外患者也可能出現有一些像是睡眠困難、疲累、僵硬和沮喪的狀況，這些症狀可能會影響患者從事運動，但研究顯示大部分的患者是可以執行運動訓練的。運動訓練包括有氧訓練，像是登階和走路；肌力訓練，像是舉重物或是機械式的抗阻力訓練；而柔軟度訓練則是伸展。 雖然運動只是處理纖維肌痛症後群的方法之一，但本次針對運動介入的回顧在於評估運動介入或是運動合併其他像是衛教、生物回饋和藥物治療的效果，而參與有氧訓練的纖維肌痛症候群的患者呈現較佳的狀況。 雖然運動只是處理纖維肌痛症後群的方法之一，但本次針對運動介入的回顧在於檢視單獨的運動介入或是運動合併其他像是衛教、生物回饋和藥物治療的效果，而結果顯示參與有氧訓練的纖維肌痛症候群的患者皆呈現較佳的狀況。研究顯示，在有氧運動的部分，每週需要進行兩天，每次至少從事20分鐘以上；在肌力訓練的部分，每週需施行2∼3次以上，執行時每個動作需重複8∼12次。 有氧運動計畫為期12∼24週，和無運動組比較，有氧運動訓練或許能夠達到減輕疼痛的效用，因此在0∼10級的疼痛評估量表中可以減輕2個等級的疼痛分數，以及提升1個等級的整體安適感，增加有氧運動表現，在跑步機上的耗氧量達2.9 ml/kgs、增加整體的抗壓性，壓痛可承受的力量為3kgs，但是對於疲勞、沮喪和僵硬的影響情形並不清楚，而這些結果有著中等級的證據力。關於纖維肌痛症候群患者參與肌力訓練的最佳情況：和無運動組比較，肌力訓練能夠減少疼痛，因此在0∼100分的計分中可以減低49分，整體安適感可以增進41分，在在0∼18壓痛點的計分中也減少了2分，這些結果有著低等級的證據力。