An exercise program that incorporates walking, strength training and stretching may improve daily function and alleviate symptoms in women with fibromyalgia, according to a report in the November 12, 2007 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. These benefits appear to be enhanced when exercise is combined with education about managing the disease.

Fibromyalgia affects approximately 3.4 percent of women and 0.5 percent of men in the United States, according to background information in the article. Patients with fibromyalgia experience chronic pain throughout their bodies for at least three months, along with specific sites of tenderness. Causes and mechanisms are poorly understood. “Even with the recent approval of pregabalin by the Food and Drug Administration to treat fibromyalgia symptoms, pharmacotherapy is often insufficient to resolve persistent symptoms or improve functional limitations and quality of life,” the authors write.

Daniel S. Rooks, Sc.D., from Brigham & Women’s Hospital and Harvard Medical School, Boston, and now with Novartis Institutes for Biomedical Research, Inc., Cambridge, Mass., and colleagues recruited 207 women taking medication for fibromyalgia between 2002 and 2004. For 16 weeks, the women were randomly assigned to four groups: 51 performed aerobic and flexibility exercises only; 51 added in strength training; 50 received a self-help course on managing fibromyalgia; and 55 participated in all the exercises and the education course. The exercise groups met twice weekly, gradually increasing the length and intensity of their workouts, with instructions to perform a third day of exercise on their own.

A total of 135 women completed the study and underwent a six-month follow-up assessment. As measured by two self-assessment questionnaires and one performance test, women who participated in all forms of exercise improved their physical function, an effect that was larger in the combined education and exercise group. “Social function, mental health, fatigue, depression and self-efficacy also improved,” the authors write. “The beneficial effect on physical function of exercise alone and in combination with education persisted at six months.”

“The present study suggests that progressive walking, simple strength training movements and stretching activities are effective at improving physical, emotional and social function, key symptoms and self-efficacy in women with fibromyalgia who are being actively treated with medication,” the authors write. “Furthermore, the benefits of exercise are enhanced when combined with targeted self-management education, and improvements in physical function continue for six months after completion of the intervention. Our findings suggest the need for inclusion of appropriate exercise and patient education in the treatment of individuals with fibromyalgia.”

Fibromyalgia (FM) is a chronic pain disorder characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any body part can be affected. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

• Stressful or traumatic events, such as car accidents
• Repetitive injuries
• Illness
• Certain diseases.

Fibromyalgia can also occur on its own.  Some scientists think that a gene or genes might be involved in fibromyalgia. The genes could make a person react strongly to things that other people would not find painful. People with certain other diseases may be more likely to have fibromyalgia. These diseases include:

• Rheumatoid arthritis
• Systemic lupus erythematosus (commonly called lupus)
• Ankylosing spondylitis (spinal arthritis).

Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. In June 2007, the U.S. Food and Drug Administration approved Lyrica* (pregabalin) as the first drug to treat fibromyalgia. Doctors also treat fibromyalgia with medicines approved for other purposes. Pain medicines and antidepressants are often used in treatment.

According to recent research the following approaches may help ease symptoms associated with fibromyalgia:

• Taking medicines as prescribed
• Getting enough sleep
• Exercising
• Eating well

Reference: Arch Intern Med. 2007;167(20):2192-2200.

Editor’s Note: This research was supported by an Arthritis Foundation Investigator Award (Dr. Rooks) and National Institutes of Health grants.