Not all exercise is equal, but recent meta-analyses add clarity on what type and how much is best.
Two new meta-analyses reinforce the benefit of exercise for fibromyalgia pain with added clarification on how often and for how long sessions should last.
Meanwhile, a randomised trial of virtual therapy programs addressed fatigue, a symptom that’s often overlooked.
The first meta-analysis, published in Rheumatology International, provides more specific recommendations on the type, frequency, intensity and duration of exercise than individual trials, which vary in their design and eligibility criteria.
“Greater improvements in pain relief seemed to occur in exercise programs that lasted between 13 and 24 weeks and using training sessions that lasted [over 30 mins but] no more than 60 min,” wrote study author Maria Luiza Albuquerque and colleagues from the University of Beira Interior in Portugal.
The meta-analysis covered 16 randomised clinical trials involving nearly 790 fibromyalgia patients, doing two to three exercise sessions a week.
Aerobic and strengthening exercises were found to relieve fibromyalgia pain and lessen the impact of the condition. However, results were better for combined training protocols and aerobic exercises than for strength exercises alone. Stretching had little benefit.
“Working out which type of exercise is the most beneficial for fibromyalgia patients has always been an issue,” said Professor Geoffrey Littlejohn, a rheumatologist specialising in fibromyalgia at Monash Health in Melbourne.
“It has to be individualised to each patient,” he said, adding that fibromyalgia patients should follow the general principle of “go low and go slow”, starting with low intensity exercise, several times a week.
However, exercise is only one component of a multipronged approach to fibromyalgia care that should also involve psychological support, Professor Littlejohn said.
“In fibromyalgia, it’s often psychological health – the improvement of stress and sleep – that helps tone down the pain system,” he said.
Another recent meta-analysis of 18 studies involving roughly 1,200 participants examined whether three types of exercise – aerobic exercise, resistance training and stretching – quell fibromyalgia pain and reduce depression that often accompanies the condition.
Only aerobic exercise eased depression, even though aerobic exercise, resistance training and stretching all had large and significant effects on pain and improved quality of life, the investigators report, publishing in Scientific Reports.
Other fibromyalgia symptoms aside from pain, such as disabling fatigue, muscle stiffness, neck pain and headache, were not assessed in either meta-analysis but may also benefit from exercise, Professor Littlejohn said. He noted that anxiety is a more common thread in fibromyalgia than depression, suggesting that perhaps exercise helps that as well.
Meanwhile, a multicentre UK trial involving almost 370 patients investigated phone-based cognitive behavioural approaches and personalised exercise programs in patients with stable inflammatory rheumatic disease and persistent fatigue.
Fatigue is a major concern for patients with inflammatory rheumatic diseases, yet rheumatologists often prioritise treating inflammation before addressing fatigue, said the study authors.
The research, published in The Lancet Rheumatology, found that cognitive behavioural therapy designed to help participants identify unhelpful beliefs about their condition and better manage fatigue was effective in alleviating fatigue, as were the personalised exercise programs.
The benefits persisted six months after treatment stopped, and modest improvements in quality of life and sleep were also observed.
“Cognitive behavioural therapy and personalised exercise programs delivered by telephone provided statistically and clinically significant reductions in fatigue severity and impact for a wide range of patients whose disease was otherwise stable,” study author Eva-Maria Bachmair of the Aberdeen Centre for Arthritis and Musculoskeletal Health and colleagues concluded.
Rheumatol Int 2022, online 23 May
