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Upping vigorous exercise may improve fibromyalgia

By Kathryn Doyle

NEW YORK (Reuters Health) - For those who are able, exercising once or twice more weekly may alleviate some symptoms of a chronic pain condition without making joints feel worse, according to a new study.

Previous studies have found short-term benefits of exercise for fibromyalgia, a poorly understood disorder that includes joint pain, tenderness, fatigue and depression and affects an estimated 5.8 million Americans, according to the Centers for Disease Control.

But many fibromyalgia sufferers fail to keep up with exercise programs out of fear that it will worsen pain, Dr. Eric Matteson, a rheumatologist who was not involved in the study, told Reuters Health.

"This study shows that if they're able to stay with the exercise program in the long term it actually is helpful to them," said Matteson, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minnesota.

As part of a larger study funded by the National Institutes of Health, researchers recruited 170 people who had been diagnosed with fibromyalgia, had been on medication for the condition for at least a month and reported low levels of physical activity.

Each person received a personalized aerobic exercise "prescription" based on their current fitness level, which usually meant walking around a track, according to lead author Anthony Kaleth, who designed the regimens.

Over three months the exercise programs gradually increased in intensity from twice weekly 10-minute sessions to up to four weekly 30-minute sessions of moderate exercise achieving 60 percent of maximum heart rate.

"It would be considered low to moderate intensity for the average individual," Kaleth, who specializes in exercise testing at Indiana University - Purdue University Indianapolis, told Reuters Health.

Over the three months of the program and for the next six months the participants reported their activity levels in a questionnaire.

Other questionnaires assessed how their fibromyalgia symptoms changed, including muscle impairment, overall wellbeing, pain levels and depression.

At the end of the study, 27 people said they'd sustained the exercise over all nine months, 68 increased their workout efforts for three months then decreased again and 75 were no more active than when they started.

The first two groups also reported less physical impairment and better overall wellbeing than those who did not increase their activity at all. A steady increase in intensity was linked to a slight decrease in pain, although a temporary bump in exercise was not. Depression levels did not change in any group.

"One of the best known therapeutic activities for fibromyalgia patients is exercise," Kaleth said. "Our study confirmed that result."

Any increase in activity, whether or not it was maintained, resulted in positive changes in symptoms and no increased pain, according to the findings in Arthritis Care and Research.

If they had followed the participants for a longer period of time, they might have seen more benefits for people who maintained the program, Kaleth said.

Most people use a combination of medications, including pain relievers, antidepressants and anti-seizure drugs to alleviate fibromyalgia symptoms. Doctors also recommend keeping active with walking, swimming or water aerobics, but many patients are reluctant to start exercising.

"They're more worried that it's going to be painful, but that's more of a psychological effect," Kaleth said.

Starting off too vigorously before building up endurance can be painful for anyone, with or without fibromyalgia, Matteson said.

"This is a stepping stone I think in terms of the actual result that we found," Kaleth said.

SOURCE: http://bit.ly/VQuyoP Arthritis Care and Research, online February 11, 2013.

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