A successful, long-term exercise program for women with fibromyalgia syndrome and chronic fatigue and immune dysfunction syndrome

This article describes an ongoing, long-term clinical exercise program for women with fibromyalgia syndrome (FMS), some of whom also have chronic fatigue and immune dysfunction syndrome (CFIDS). The recorded outcomes from the most recent year of the program also are reported. Participants engaged in sessions lasting 50-70 minutes, 5 days per week; each session involved aerobic activity, resistance training, and other dynamic exercise. One group was in the program for 3 years and another group was in the program for 2 years. Program outcomes for the year (comparing beginning and end-of-year results) are presented for both groups on physical fitness, psychosocial, and FMS/CFIDS symptoms. The outcomes support that all of the women appear to have benefited from the program in numerous ways, suggesting that the program works. Also, those outcomes are in agreement with past research reported in this journal. Implications for clinical nurse specialists working with FMS/CFIDS patients are discussed.     

The effects of aquatic,isometric strength-stretching and aerobic exercise on physical and psychological parameters of female patients with fibromyalgia syndrome

[Purpose] There are various treatment modalities for fibromyalgia syndrome (FMS), which is characterized by widespread pain and fatigue. The aim of this study was to investigate the effects of aquatic, aerobic and isometric strength-stretching exercises on the physical and psychological parameters of patients with FMS. [Subjects and Methods] Seventy five female patients with FMS were randomly selected and divided into three groups. Patients (18–50 years) were treated for 3 months using one of three methods: a home-based isometric strength and stretching exercise program (ISSEP), a gym-based aerobic exercise program (AEP), and a pool-based aquatic aerobic exercise program (AAEP). Items evaluated were: the number of tender points, Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), the Six-Minute Walk Test (6MWT), SF-36 physical and mental health scores, and the Beck Depression Inventory (BDI). [Results] The results revealed that AAEP was the most effective treatment of the three. All of the groups showed significant improvements in all variables between pre-and post-test, except the mean values of VAS and BDI in ISSEP. [Conclusion] The results suggest that aquatic aerobic exercise program is more effective than AEP and ISSEP in the treatment of FMS.Key words: Fibromyalgia, Exercise, Treatment     

Women with fibromyalgia’s experience with three motion-controlled video game consoles and indicators of symptom severity and performance of activities of daily living

Purpose: Little is known of Motion-Controlled Video Games (MCVGs) as an intervention for people with chronic pain. The aim of this study was to explore the experience women with fibromyalgia syndrome (FMS) had, using commercially available MCVGs; and to investigate indicators of symptom severity and performance of activities of daily living (ADL). Method: Of 15 female participants diagnosed with FMS, 7 completed a program of five sessions with Nintendo Wii (Wii), five sessions with PlayStation 3 Move (PS3 Move) and five sessions with Microsoft Xbox Kinect (Xbox Kinect). Interviews were conducted at baseline and post-intervention and were supported by data from observation and self-reported assessment. Results: Participants experienced play with MCVGs as a way to get distraction from pain symptoms while doing fun and manageable exercise. They enjoyed the slow pace and familiarity of Wii, while some considered PS3 Move to be too fast paced. Xbox Kinect was reported as the best console for exercise. There were no indication of general improvement in symptom severity or performance of ADL. Conclusion: This study demonstrated MCVG as an effective healthcare intervention for the women with FMS who completed the program, with regards to temporary pain relief and enjoyable low impact exercise.

• Implications for Rehabilitation

• Exercise is recommended in the management of fibromyalgia syndrome (FMS).

• People with FMS often find it counterintuitive to exercise because of pain exacerbation, which may influence adherence to an exercise program.

• Motion-controlled video games may offer temporary pain relief and fun low impact exercise for women with FMS.

     

Exercise program effects on women with fibromyalgia syndrome

The purpose of this study (evaluation) was to examine the effects of an exercise program on 13 women with physician-diagnosed fibromyalgia syndrome (FMS). Participants engaged in exercise for 60 minutes each session. Group 1 (N=7) was in a 3-day-per-week program for 12 months, and group 2 (N= 6) was in a 3-day-per-week program for six months. Group 3 (N= 3) consisted of three participants from Group 1 who participated for six additional months past the 12-month period (total--18 months). Group 3 attended five sessions per week during the six additional months. All participants engaged in aerobic and resistance training. Information was collected on physical fitness, psychosocial, and FMS symptom variables. A majority of the participants appeared to experience a positive outcome on numerous measures of physical fitness, psychosocial factors, and FMS symptoms. Interview data support results. The 13 participants gained various benefits from the exercise program and functioned the same or better outside of the program. Implications for advising FMS patients relative to exercise are given for clinical nurse specialists.     

Evaluation of the Effectiveness of an Aerobic Exercise Program and the Personality Characteristics of Patients with Fibromyalgia Syndrome: A Pilot Study

[Purpose] The aim of this study was to assess the effectiveness of a 6-week aerobic exercise program on pain, physical function, and psychological status, and to evaluate the personality characteristics of fibromyalgia syndrome (FMS) patients. [Subjects and Methods] Fourteen women with FMS were enrolled. They were trained for a 6-week home-based aerobic exercise program. The Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the visual analog scale of pain and sleep quality were measured at baseline and at the end of week 6. The personality profiles were evaluated using the Minnesota Multiphasic Personality Inventory (MMPI). [Results] After the exercise program, significant improvements were determined in pain, sleep quality, physical function, depression and FMS symptoms compared to baseline. In addition, the hysteria item (71.21±8.84) of the MMPI was significantly higher in FMS. [Conclusion] Our findings indicate that home-based aerobic exercise may be a useful treatment in the management of FMS. Personality characteristics should be considered during the planning process of the treatment of FMS. Personality is a filter between life events and psychological responses. It is defined to be the integration of effective and behavioral patterns. Long-term studies involving larger clinical samples are needed to define the role of personality characteristics in FMS.Key words: Fibromyalgia syndrome, Aerobic exercise, Personality characteristics     

Effect of Pilates Training on People With Fibromyalgia Syndrome: A Pilot Study

Altan L, Korkmaz N, Bingol Ü, Gunay B. Effect of Pilates training on people with fibromyalgia syndrome: a pilot study.ObjectiveTo investigate the effects of Pilates on pain, functional status, and quality of life in fibromyalgia, which is known to be a chronic musculoskeletal disorder.DesignRandomized, prospective, controlled, and single-blind trial.SettingPhysical medicine and rehabilitation department.ParticipantsWomen (N=50) who had a diagnosis of fibromyalgia syndrome (FMS) according to the American College of Rheumatology criteria.InterventionThe participants were randomly assigned into 2 groups. In group 1, a Pilates exercise program of 1 hour was given by a certified trainer to 25 participants 3 times a week for 12 weeks. In group 2, which was designed as the control group, 25 participants were given a home exercise (relaxation/stretching) program. In both groups, pre- (week 0) and posttreatment (week 12 and week 24) evaluation was performed by one of the authors, who was blind to the group allocation.Main Outcome MeasuresPrimary outcome measures were pain (visual analog scale) and Fibromyalgia Impact Questionnaire (FIQ). Exploratory outcome measures were number of tender points, algometric score, chair test, and Nottingham Health Profile.ResultsTwenty-five Pilates exercise and 24 relaxation/stretching exercise participants completed the study. In group 1, significant improvement was observed in both pain and FIQ at week 12 but only in FIQ at 24 weeks. In group 2, no significant improvement was obtained in pain and FIQ at week 12 and week 24. Comparison of the 2 groups showed significantly superior improvement in pain and FIQ in group 1 at week 12 but no difference between the 2 groups at week 24.ConclusionsWe suggest Pilates as an effective and safe method for people with FMS. Our study is the first clinical study designed to investigate the role of the Pilates method in FMS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method.     

Effects of yoga and the addition of Tui Na in patients with fibromyalgia

OBJECTIVES: This study aimed to verify whether techniques of yoga with and without the addition of Tui Na might improve pain and the negative impact of fibromyalgia (FMS) on patients' daily life. DESIGN: Forty (40) FMS women were randomized into two groups, Relaxing Yoga (RY) and Relaxing Yoga plus Touch (RYT), for eight weekly sessions of stretching, breathing, and relaxing yogic techniques. RYT patients were further submitted to manipulative techniques of Tui Na. OUTCOME MEASURE: Outcome measures comprised the Fibromyalgia Impact Questionnaire (FIQ), pain threshold at the 18 FMS tender points, and a verbal graduation of pain assessed before treatment and on the followup. The visual analog scale (VAS) for pain was assessed before and after each session and on the follow-up. RESULTS: Seventeen (17) RYT and 16 RY patients completed the study. Both RY and RYT groups showed improvement in the FIQ and VAS scores, which decreased on all sessions. The RYT group showed lower VAS and verbal scores for pain on the eighth session, but this difference was not maintained on the follow-up. Conversely, RY VAS and verbal scores were significantly lower just on the follow-up. CONCLUSIONS: These study results showed that yogic techniques are valid therapeutic methods for FMS. Touch addition yielded greater improvement during the treatment. Over time, however, RY patients reported less pain than RYT. These results suggest that a passive therapy may possibly decrease control over FMS symptoms.     

Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program

BACKGROUND AND PURPOSE: Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis (OA) of the knee. The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinically based physical therapy program. SUBJECTS: One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinic treatment group (n=66; 61% female, 39% male; mean age [+/-SD]=64+/-10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [+/-SD]=62+/-9 years). METHODS: Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. DISCUSSION AND CONCLUSION: Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.     

Therapeutic approaches to fibromyalgia syndrome in the United Kingdom: a survey of occupational therapists and physical therapists.

BACKGROUND AND PURPOSE: This study sought information from occupational therapists (OTs) and physical therapists (PTs) working in rheumatology in the UK on their usual methods of treatment and management of patients with fibromyalgia syndrome (FMS). METHODS. Data were gathered by self-completion questionnaire on: work setting; referrals of FMS patients; usual treatment objectives; assessment and treatment approaches; perceived responsiveness of patients; and other perceptions of the management of FMS. Most data were in the form of frequency counts, with some ordinal scales and open responses. RESULTS: Responses were obtained from 142 therapists (71% response rate), of whom 47 OTs and 39 PTs managed patients with FMS. The foremost therapeutic objective was increased functional ability for OTs, and increased exercise tolerance and general fitness for PTs. Pain reduction or management was rated as the second objective for both groups. An endurance-based exercise program and energy conservation techniques were the most frequently utilized interventions. Patients with FMS were thought to be 'moderately responsive' to physical management. Predictors of outcome were considered to be largely psychosocial, rather than physical, in nature. CONCLUSION: These data provide a preliminary profile of current practice in the management of FMS among UK therapists and indicate certain differences in approach between OTs and PTs.     

Fitness and perceived exertion in patients with fibromyalgia syndrome

OBJECTIVE: The aim of this study was to evaluate the cardiorespiratory fitness and perceived exertion of female patients with fibromyalgia syndrome (FMS) compared with that of healthy female subjects. DESIGN AND SUBJECTS: This was designed as a cross-sectional case-control study, with a consecutive sample of 30 female patients with FMS and an age-matched control group of 67 healthy female subjects. SETTING: This study was conducted at the multidisciplinary pain center of a university hospital in a city of more than 1 million inhabitants. OUTCOME MEASURES: A cardiorespiratory fitness index (PWC65%/kg) and an original perceived exertion index (B65%) were obtained from the heart rates and perceived exertions scored on a 10-point Borg scale during a submaximal cycle ergometer test. Average indexes for the FMS patients and control subjects were compared. RESULTS: The mean cardiorespiratory fitness index of the FMS patients was not significantly different from that of the controls. The mean perceived exertion index in the FMS patients was significantly greater than that of the controls, meaning that the FMS patients systematically reported higher ratings of perceived exertion during exercise. CONCLUSIONS: Cardiorespiratory fitness, as expressed by a submaximal work capacity index, seems normal in female patients with FMS compared with age- and sex-matched healthy individuals. The fact that FMS patients overscore their perception of exertion may be due to a greater overlap of peripheral pain and perceived exertion perceptions during exercise. This observation should be noted when using perceived exertion scores to prescribe and monitor exercise in FMS patients.     

Prevention and rehabilitation of osteoporosis program: exercise and osteoporosis

Osteoporosis is a common crippling bone disease affecting post-menopausal and elderly women. It results in fractures, spinal deformity and chronic pain leading to decreased mobility and functional disability. A preventive program in Toronto, described in this article, aims to prevent bone loss and maximise the functional capacity of osteoporotic patients through a program with educational, social and exercise components. Evaluation of the program, also reported here, showed that 80 per cent of patients complied with the requirements of the exercise program and that those who exercised reported improvement in general well being, stamina, mobility and pain tolerance. The exercise group also showed a significant improvement in VO 2 max (p less than 0.001) and bone mass (p less than 0.02) after one year of exercise. None of the patients developed fracture as a direct result of the exercise. The exercise prescribed for osteoporosis is safe and beneficial. The program is a social success.     

Self-Referral and the Boutique Hospital Industry

Abstract

Six individuals suffering from chronic cervicogenic headache were the subjects of a series of case studies involving manual therapy, exercise, and a home-exercise program. Headache duration ranged from three months to twenty years. During the course of treatment, the subjects maintained a journal tracking duration, frequency, and intensity of their headaches as well as any relieving factors. The purpose of this series of studies was to describe the use of manual therapy and exercise in the treatment of chronic cervicogenic headaches. Subjects were treated using a custom home-exercise protocol; manual therapy involving soft tissue and non-thrust joint manipulation, aerobic conditioning, and resistance exercise. The Pain Disability Index (PDI) was used as the functional improvement scale. The PDI was administered pre-, post- and six months post-treatment. Five of the six subjects reported improvement. These five subjects were seen for an average of 5.9 sessions over an average of 3.8 weeks. The average improvement on the PDI was 29.5% at discharge and 28.8% at 6- month follow-up. The five subjects each reported the need to continue their home exercise program in order to control their headaches at 6-month follow-up. A voluntary decrease in medication intake was also reported by five of the six subjects at discharge. Six-month follow-up showed that these five patients were still taking less medication than reported at time of the intial examination. No follow-up data was available for the patient which reported no improvement. The results of these case studies seem to indicate that a treatment regimen of exercise and manual therapy can be beneficial in the treatment of chronic cervicogenic headaches.     

On a happier note: validation of musical exercise for older persons in long-term care settings

This paper describes a quasi-experimental study of a musical exercise intervention to improve the physical, cognitive, behavioral status and life satisfaction of older residents in a long-term care facility in the United Kingdom. Twenty long-term care residents from three different units (n=60) were recruited and assigned to one of three groups: a control (C) group (no intervention), an occupational therapy (OT) group (comparison group) and a music exercise group (intervention group). Assessments of physical and cognitive status were made pre-intervention and repeated at the end of the 10-week exercise program and again 10 weeks after the completion of the program. The results show that both OT and exercise participation is associated with improvement in physical and cognitive function. However, the exercise group showed significant improvement in more areas than the OT group. The functional benefits from OT and exercise were not sustainable after these activities ceased and showed significant decline 10 weeks after the end of the programs.     

Clinical follow-up study on diabetes patients participating in a health management plan

The "Health Management Plan"(HMP) for caring diabetic patient was begun by the National Health Insurance (NHI) in Taiwan in order to maximize the effectiveness of limited medical resources. This study describes the clinical experience of the nurse-directed diabetic HMP program and analyzes factors associated with the outcome. One hundred and thirty-six patients, all of whom had participated in the diabetic HMP program at least 5 times, were enrolled in the study. The effect of the HMP was evaluated by comparing hemoglobin A1C status before and after %) maintained their hemoglobin A1C status over the course of HMP participation. Diabetic patients with regular exercise habits showed a 2.8-fold increased chance of outcome improvement compared with those who did not exercise regularly. The chance of outcome improvement in patients with complications was found to be one-third that of patients who had no complications (Odds ratio: 0.3, 95% CI: 0.1-1.0). This study found that specially trained nurses, following agreed upon protocols and algorithms and collaborating with medical team members, can effectively concentrate on providing comprehensive and effective diabetes care.     

Exercise as a Treatment for Fibromyalgia: A Scoping Review

Fibromyalgia is a chronic, disabling condition that is both challenging to manage and frustrating for the patient and primary care provider. The aim of this scoping review is to explore how nondrug treatments, such as exercise, can reduce pain and promote physical function in adults with fibromyalgia (FMS). The body of literature on exercise as a treatment for FMS has identified beneficial effects, but there is no standardized approach for prescribing an exercise regimen in primary care. We conclude with a synthesis of general recommendations for exercise approaches to support care for patients with FMS.     

A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial

OBJECTIVE: To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke. DESIGN: Randomized controlled trial. SETTING: Rehabilitation research laboratory and a community hall. PARTICIPANTS: A sample of 63 people (> or =50y) with chronic deficits resulting from stroke (onset > or =1y). INTERVENTIONS: The arm group underwent an exercise program designed to improve upper-extremity function (1h/session, 3 sessions/wk for 19wk). The leg group underwent a lower-extremity exercise program. MAIN OUTCOME MEASURES: The Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (FMA), hand-held dynamometry (grip strength), and the Motor Activity Log. RESULTS: Multivariate analysis showed a significant group by time interaction (Wilks lambda=.726, P=.017), indicating that overall, the arm group had significantly more improvement than the leg group. Post hoc analysis demonstrated that gains in WMFT (functional ability) (P=.001) and FMA (P=.001) scores were significantly higher in the arm group. The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke. Participants with moderate arm impairment benefited more from the program. CONCLUSIONS: The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke. This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness.     

A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis.

OBJECTIVE: To compare the efficacy of aquatic exercise and a land-based exercise programme vs control in patients with knee osteoarthritis. METHODS: Primary outcome was change in pain, and in addition Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS). Standing balance and strength was also measured after and at 3-month follow-up. Seventy-nine patients (62 women), with a mean age of 68 years (age range 40-89 years) were randomized to aquatic exercise (n = 27), land-based exercise (n = 25) or control (n = 27). RESULTS: No effect was observed immediately after exercise cessation (8 weeks). At 3-month follow-up a reduction in pain was observed only in the land-based exercise group compared with control (-8.1 mm, (95% confidence interval -15.4 to -0.4; p = 0.039), but no differences between groups were observed for KOOS; and no improvement following aquatic exercise. Eleven patients reported adverse events (i.e. discomfort) in land-based exercise, while only 3 reported adverse events in the aquatic exercise. CONCLUSION: Only land-based exercise showed some improvement in pain and muscle strength compared with the control group, while no clinical benefits were detectable after aquatic exercise compared with the control group. However, aquatic exercise has significantly less adverse effects compared with a land-based programme.     

Fibromyalgia and Exercise Training: A Systematic Review of Randomized Clinical Trials

Abstract

Objective. This review evaluates the effects of exercise training for individuals with fibromyalgia syndrome (FMS).

Methods. Seven bibliographic indices (1966–2000) were searched for experimental studies containing physical exercise training for FMS. The methodological quality and adequacy of training stimulus were rated. Studies meeting ≥50% of the quality criteria and applying adequate exercise training stimulus were classified as High Quality Training Studies (HQTS).

Results. Fourteen experimental trials were found; six were HQTS of aerobic exercise. In the HQTSs, improvements reported were: tender points =4 of 4 of the HQTS using this outcome measure; cardiorespiratory fitness =3 of 4; global well-being =3 of 5; and fatigue and sleep =2 of 5. There is moderate benefit in FMS from supervised aerobic exercise training. Details about dosage for muscle strengthening or flexibility training were insufficient to evaluate the adequacy of the training stimulus. Further research is needed to describe the long term effects of all types of exercise training and to examine strengthening and flexibility training in FMS.