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A prospective randomized controlled trial Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial.
OBJECTIVE To investigate the effects of supervised aerobic exercise ( AE ) and a combined program of supervised aerobic , muscle strengthening , and flexibility exercises ( combined exercise [ CE ] ) on important health outcomes in women with fibromyalgia syndrome ( FMS ) . DESIGN R and omized controlled trial . SETTING Community-based supervised intervention . PARTICIPANTS Women ( N=64 ) with a diagnosis of FMS according to the American College of Rheumatology criteria . INTERVENTION Participants were r and omly allocated to 1 of 3 groups : supervised AE , supervised CE , or usual-care control . Exercise sessions were performed twice weekly ( 45 - 60min/session ) for 24 weeks . MAIN OUTCOME MEASURES The primary outcome measure was the Fibromyalgia Impact Question naire ( FIQ ) . Exploratory outcome measures were the 36-Item Short-Form Health Survey , Beck Depression Inventory ( BDI ) , aerobic capacity ( 6-minute walk test ) , h and -grip strength , and range of motion in the shoulders and hips . RESULTS Compliance with both interventions was excellent , with women in the exercise groups attending more than 85 % of sessions . A 14 % to 15 % improvement from baseline in total FIQ score was observed in the exercise groups ( P≤.02 ) and was accompanied by decreases in BDI scores of 8.5 ( P<.001 ) and 6.4 ( P<.001 ) points in the AE and CE groups , respectively . Relative to nonexercising controls , CE evoked improvements in the SF-36 Physical Functioning ( P=.003 ) and Bodily Pain ( P=.003 ) domains and was more effective than AE for evoking improvements in the Vitality ( P=.002 ) and Mental Health ( P=.04 ) domains . Greater improvements also were observed in shoulder/hip range of motion and h and grip strength in the CE group . CONCLUSION Given the equivalent time commitment required for AE and CE , our results suggest that women with FMS can gain additional health benefits by engaging in a similar volume of CE OBJECTIVES To examine the effects of a supervised aerobic exercise programme on heart rate variability ( HRV ) parameters and symptom severity in women with fibromyalgia ( FM ) . METHODS Thirty-two women with FM were r and omly allocated to one of two groups : aerobic exercise ( AE ) or usual care control for 24 weeks . Women allocated to AE performed two aerobic exercise sessions per week of 45 - 60 min duration including 15 - 20 min of steady-state aerobic exercise at 60 - 65 % of predicted maximum heart rate ( HRmax ) and 15 min of interval training at 75 - 80 % HRmax ( six repetitions of 1.5 min , with 1 min interpolated rest intervals ) . Cardiac autonomic modulation was assessed using power spectral analysis of HRV . Symptom severity was assessed by a 10 cm visual analogue scale ( VAS ) for pain , sleep disturbances , stiffness , anxiety and depression . RESULTS After 24 weeks , the women in the exercise group showed an increase ( 4.8 ± 0.2 to 5.2 ± 0.2 ) in total power ( LnTP , p<0.001 ) , low frequency power ( LnLF , p<0.01 ) , high frequency power ( LnHF , p<0.001 ) , and the root-mean-square of successive R-R intervals ( rMSSD , p<0.001 ) . In addition , significant group-by-time interaction effects were observed for LnHF ( p=0.036 ) and LnLF/HF ( p=0.014 ) . Improvements in anxiety and depression were also observed in AE versus control patients . CONCLUSIONS These results show that a programme of aerobic exercise training  induced changes in cardiac autonomic nervous system modulation in FM and that these changes in HRV parameters were accompanied by changes in anxiety and depression Aim Previous systematic review s have found hydrotherapy to be an effective management strategy for  fibromyalgia syndrome ( FMS ) .  The aim of this systematic review was to summarize the components of hydrotherapy programs used in r and omized controlled trials . Method A systematic review of r and omized controlled trials was conducted . Only trials that have reported significant FMS-related outcomes were included . Data relating to the components of hydrotherapy programs ( exercise type , duration , frequency and intensity , environmental factors , and service delivery ) were analyzed . Results Eleven r and omized controlled trials were included in this review . Overall , the quality of trials was good . Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component . Great variability was noted in both the environmental components of hydrotherapy programs and service delivery . Conclusions Aerobic exercise , warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes . Treatment duration of 60 minutes , frequency of three sessions per week and an intensity equivalent to 60%–80 % maximum heart rate were the most commonly reported exercise components . Exercise appears to be the most important component of an effective hydrotherapy program for FMS , particularly when considering mental health-related outcomes OBJECTIVE To assess the utility of an exercise program , which included aerobic , flexibility and strengthening elements , in the treatment of fibromyalgia ( FM ) . FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching . It has been suggested that aerobic exercise is helpful in its treatment . METHODS We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities . Measurements performed on each patient at the pre and post study assessment included the number of tender points ( TP ) , total myalgic scores ( TM ) , aerobic fitness ( AF ) , flexibility and isokinetic strength . After initial evaluation patients were r and omly assigned to either an exercise or a relaxation group . Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation . All patients data were stored in a computerized data base and statistical analysis was performed on all pre and post study assessment s. RESULTS Thirty-eight patients ( 18 exercise and 20 relaxation ) completed the study . Analysis of our data showed no significant difference between the groups in their pre study assessment . Post study assessment s , however , showed a significant improvement between the exercise and relaxation groups in TP ( p < 0.05 ) , TM ( p < 0.05 ) , and AF ( p < 0.05 ) . Similar improvements were also found when the pre and post study assessment of the exercise group were compared . CONCLUSION Exercise is helpful in the management of FM in the short term . It also shows that FM patients can undertake an exercise program which includes aerobic , flexibility , and strength training exercises without adverse effects . The long term utility of this type of exercise requires further evaluation OBJECTIVE Treatment recommendations for fibromyalgia ( FM ) include regular physical exercise . In this prospect i ve study we examined predictors for adherence to stretching and aerobic exercises in women provided with an individualized home based program .  METHODS Thirty-nine women kept exercise diaries for 12 weeks . RESULTS For both types of exercise , women who were less physically fit at baseline engaged in more exercise during the program . Yet for stretching , more lower body pain at baseline predicted engaging in less stretching exercise over time , whereas for aerobic exercise , more baseline upper body pain predicted more exercise over time . As time passed , participants with higher baseline physical fitness and /or older age were reducing their aerobic exercise practice at significantly faster rates , as were those women with higher baseline stress . CONCLUSION Given that adequate levels of adherence were limited to about half of the participants for both types of exercise , steps to reduce barriers to exercise ( e.g. , stress ) need to be taken when prescribing exercise in the treatment of FM 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 . Implication s for clinical nurse specialists working with FMS/CFIDS patients are discussed BACKGROUND In the literature , it is not yet clear whether sex may affect the outcomes of exercise training in obese adults . AIM The aim of this study was to investigate gender difference in the effects of combined aerobic resistance exercise ( ARE ) versus aerobic exercise ( AE ) alone on body composition in overweight and obese adults . DESIGN R and omized clinical trial . SETTING University-based outpatient clinic . POPULATION Sixty-five healthy , untrained overweight and obese men and women METHODS They were r and omized into one of two intervention groups ; AE group ( N.=33 ) performed leg cycle exercises with increasing duration and frequency ; ARE group ( N.=32 ) performed additionally progressive weight-resistance exercises for the upper and lower parts of body . Both groups were asked not to change their diet . Body composition including percentage of fat ( PF ) , fat mass ( FM ) and fat free mass ( FFM ) in regional and whole body was determined by dual-energy X-ray absorptiometry ( DXA ) at baseline and week 12 . RESULTS ARE leads to more gains on regional and whole body FFM than AE . ARE was more effective in increasing the FFM of arms , trunk and whole body and decreasing PF of trunk in men and superior on reducing FM of legs in women when comparing with AE . CONCLUSION In order to reduce the trunk fat in men and leg fat in women , resistance exercise can be added into an aerobic training program . CLINICAL REHABILITATION IMPACT Dissimilar results of exercises on sex obtained in our study serves as a guide for prescribing exercises in overweight and obese men and women OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice This study aim ed to examine the effectiveness of a multidisciplinary intervention with aftercare ( MD ) compared to aerobic exercise ( AE ) and usual care ( UC ) in recently diagnosed patients with fibromyalgia ( FM ) . In a Zelen-like design , eligible patients from the outpatient rheumatology clinics of three medical centres in the South of the Netherl and s were consecutively recruited and pre-r and omised to MD ( n = 108 ) , AE ( n = 47 ) or UC ( n = 48 ) .  MD consisted of a 12-week course of sociotherapy , physiotherapy , psychotherapy and creative arts therapy ( three half days per week ) , followed by five aftercare meetings in 9 months . AE was given twice a week in a 12-week course . UC varied but incorporated at least education and lifestyle advice . Primary outcomes were health-related quality of life ( HR-Qol ) , participation and health care utilisation . Secondary outcome was the Fibromyalgia Impact Question naire ( FIQ ) . Total follow-up duration of the study was 21–24 months . As willingness to participate in AE was limited , this group has been analysed but interpretation of the data is considered arguable . Within the MD group , a statistically significantly improved HR-Qol and a statistically significant reduction in number of hours sick leave , number of contacts with general practitioners and number of contacts with medical specialists was found . Moreover , statistically significant improvements were found on the FIQ , which increased after the intervention . However , no statistically significant between-group differences were found at the endpoint of the study . MD seemed to yield positive effects , but firm conclusions with regard to effectiveness can not be formulated due to small between-group differences and limitations of the study OBJECTIVES To compare the cognitive function performance in patients with fibromyalgia ( FM ) with respect healthy controls and to evaluate the short-term efficacy of exercise therapy in a warm , chest-high pool on pain and cognitive function in women with FM . METHODS Sixty middle-aged women with FM were r and omly assigned to either an exercise training group ( n = 35 ) to perform 3 sessions per week of aquatic training ( 32 degrees C ) including mobility , aerobic , strengthening , and relaxation exercises for 16 weeks , or a control group ( n = 25 ) . Twenty-five healthy women matched for age , weight , body mass index , and educational and physical activity levels were recruited .  Pain was assessed in patients using a syringe calibrated like a pressure dolorimeter , and a visual analog scale . The severity of FM was evaluated using the Fibromyalgia Impact Question naire . Cognitive function was measured in healthy individuals and patients using several st and ardized neuropsychological tests . All patients were measured at baseline and post-treatment . RESULTS At baseline , the healthy group evidence d cognitive performance that was significantly superior to the group of patients with FM in all of the neuropsychological tests . The exercise group significantly improved their pain threshold , tender point count , self-reported pain , severity of FM , and cognitive function , while in the control group the differences were not significant . CONCLUSION An exercise therapy three times per week for 16 weeks in a warm-water pool is an adequate treatment to decrease the pain and severity of FM well as to improve cognitive function in previously unfit women with FM and heightened painful symptomatology OBJECTIVE To identify predictors of maintenance of exercise for women with fibromyalgia ( FM ) . METHODS Women with FM who had been r and omized to the exercise arm of a clinical trial were studied prospect ively during and 3 months following treatment . Subjects completed exercise logs weekly and returned the data via postal mail . Outcome variables were duration of aerobic and stretching exercises .  Two separate multivariate models for longitudinal data were built with adjustment for in-treatment adherence and time . Pretreatment characteristics ( self efficacy , pain , disability , stress , exercise barriers and benefits , and age ) and changes during treatment ( pain , disability , stress , and exercise barriers and benefits ) were considered potential predictors of exercise maintenance . RESULTS  Stretching  significantly decreased in the 3 months following treatment . High stress at baseline and increases in stress during treatment were associated with poor maintenance of stretching . Disability at baseline ( measured with the Fibromyalgia Impact Question naire ) , an increase in barriers to exercise during treatment , and increases in upper-body pain during treatment were associated with worse maintenance of aerobic exercise in the 3 months following treatment . CONCLUSION The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress , pain , barriers to exercise , and disability OBJECTIVE To determine the feasibility of conducting a r and omized controlled trial of a 12-week exercise intervention in children with fibromyalgia ( FM ) and to explore the effectiveness of aerobic exercise on physical fitness , function , pain , FM symptoms , and quality of life ( QOL ) . METHODS FM patients ages 8 - 18 years were r and omized to a 12-week exercise intervention of either aerobics or qigong . Both groups participated in 3 weekly training sessions . Program adherence and safety were monitored at each session . Data were collected at 3 testing sessions , 2 prior to and 1 after the intervention , and included FM symptoms , function , pain , QOL , and fitness measures . RESULTS Thirty patients participated in the trial . Twenty-four patients completed the program ; 4 patients dropped out prior to training and 2 dropped out of the aerobics program . Better adherence was reported in the aerobics group than in the qigong group ( 67 % versus 61 % ) . Significant improvements in physical function , functional capacity , QOL , and fatigue were observed in the aerobics group . Anaerobic function , tender point count , pain , and symptom severity improved similarly in both groups . CONCLUSION It is feasible to conduct an exercise intervention trial in children with FM . Children with FM tolerate moderate-intensity exercise without exacerbation of their disease . Significant improvements in physical function , FM symptoms , QOL , and pain were demonstrated in both exercise groups ; the aerobics group performed better in several measures compared with the qigong group . Future studies may need larger sample sizes to confirm clinical improvement and to detect differences in fitness in childhood FM OBJECTIVE To compare 2 exercise modalities , aerobic fitness training and stretching exercises , in patients with fibromyalgia ( FM ) in relation to function , pain , quality of life , depression , and anxiety , and to correlate the cardiorespiratory fitness gain with symptom improvement . METHODS Seventy-six women with FM between 18 and 60 years old were r and omized to either an aerobic program or stretching program , for 20 weeks . They were evaluated at the beginning of the program and after 10 and 20 weeks in relation to the improvement of aerobic fitness , flexibility , function , Fibromyalgia Impact Question naire ( FIQ ) , Short-form Health Survey ( SF-36 ) , and depression and anxiety levels . Ventilatory anaerobic threshold ( VT ) and maximum oxygen uptake ( VO2max ) were determined by expired gas analyses . RESULTS Aerobic exercise was superior to stretching in relation to VO2 max , VT , function , depression , pain , and the emotional aspects and mental health domains of SF-36 . Patients in the stretching group showed no improvement in depression , " role emotional , " and " mental health . " No association was noted between improvement in aerobic fitness as measured by VT and the improvement of pain , function , or scores in FIQ and SF-36 . CONCLUSION Our results confirm that aerobic exercise is beneficial to patients with FM , but the cardiorespiratory fitness gain is not related to improvement of FM symptoms OBJECTIVE To determine the safety , feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome ( FMS ) . METHODS Fifteen women with confirmed FMS were monitored for injury and exercise compliance , and assessed for muscle strength ( 1-repetition maximum technique ) , cardiovascular endurance ( 6-minute walk test ) , and functional status ( Fibromyalgia Impact Question naire [ FIQ ] ) before and after a 20-week exercise intervention . RESULTS Zero injuries and an 81 % compliance rate occurred during training . Improvement was seen in muscle strength of the lower ( 191 + /- 75 to 265 + /- 67 pounds ; P < 0.001 ) and upper ( 61 + /- 18 to 76 + /- 18 pounds ; P < 0.001 ) body , 6-minute walk distance ( 530 + /- 80 to 629 + /- 74 meters ; P < 0.001 ) , and in FIQ score ( 44 + /- 9 to 32 + /- 14 ; P < 0.01 ) . CONCLUSION A program of progressive strength training and cardiovascular exercise can be safe , well tolerated , and effective at improving muscle strength , cardiovascular endurance and functional status in women with FMS without exacerbating symptoms . This program may also contribute to a reduction in the severity of several symptoms BACKGROUND : Sleep disorders affect many patients with chronic pain conditions . Cannabis has been reported by several patient population s to help sleep . We evaluated the safety and efficacy of nabilone , a synthetic cannabinoid , on sleep disturbance in fibromyalgia ( FM ) , a disease characterized by widespread chronic pain and insomnia . METHODS : We conducted a r and omized , double-blind , active-control , equivalency crossover trial to compare nabilone ( 0.5–1.0 mg before bedtime ) to amitriptyline ( 10–20 mg before bedtime ) in patients with FM with chronic insomnia . Subjects received each drug for 2 wk with a 2-wk washout period . The primary outcome was sleep quality , measured by the Insomnia Severity Index and the Leeds Sleep Evaluation Question naire . Secondary outcomes included pain , mood , quality of life , and adverse events ( AEs ) . RESULTS : Thirty-one subjects were enrolled and 29 completed the trial ( 26 women , mean age 49.5 yr ) . Although sleep was improved by both amitriptyline and nabilone , nabilone was superior to amitriptyline ( Insomnia Severity Index difference = 3.2 ; 95 % confidence interval = 1.2–5.3 ) . Nabilone was marginally better on the restfulness ( Leeds Sleep Evaluation Question naire difference = 0.5 [ 0.0–1.0 ] ) but not on wakefulness ( difference = 0.3 [ −0.2 to 0.8 ] ) . No effects on pain , mood , or quality of life were observed . AEs were mostly mild to moderate and were more frequent with nabilone . The most common AEs for nabilone were dizziness , nausea , and dry mouth . CONCLUSIONS : Nabilone is effective in improving sleep in patients with FM and is well tolerated . Low-dose nabilone given once daily at bedtime may be considered as an alternative to amitriptyline . Longer trials are needed to determine the duration of effect and to characterize long-term safety Background There are no approved medications for juvenile fibromyalgia ( JFM ) , a disorder that is often under-diagnosed . The effects of milnacipran , a drug approved for the management of fibromyalgia ( FM ) in adults , was assessed in a clinical trial program for JFM . Methods Patients , ages 13–17 years who met the Yunus and Masi criteria for JFM and /or 1990 American College of Rheumatology criteria for FM , were enrolled in a responder-enriched , r and omized withdrawal trial . After receiving open-label milnacipran ( 8 weeks ) , patients with ≥50 % improvement in pain underwent double-blind r and omization ( 1:2 ) to either placebo or continuing treatment with milnacipran ( 8 weeks ) . All patients , including those who did not meet the r and omization criteria for double-blind withdrawal , were allowed to enter an extension study with open-label milnacipran ( up to 52 weeks ) . The primary endpoint was loss of therapeutic response ( LTR ) during the double-blind period . Additional outcome measures included the Patient Global Impression of Severity ( PGIS ) , Pediatric Quality of Life Inventory ( PedsQL : Generic Core Scales , Multidimensional Fatigue Scale ) , and Multidimensional Anxiety Scale for Children ( MASC ) . Safety assessment s included adverse events ( AEs ) , vital signs , electrocardiograms , and laboratory tests . Results The milnacipran program was terminated early due to low enrollment . Because only 20 patients were r and omized into the double-blind withdrawal period , statistical analyses were not conducted for the LTR endpoint . However , 116 patients entered the open-label period of the initial study and 57 participated in the open-label extension study . Their experience provides preliminary information about the use of milnacipran in JFM patients . During both open-label periods , there were mean improvements in pain severity , PGIC , PedsQL , and MASC scores . No unexpected safety issues were detected . The most commonly reported treatment-emergent AEs were nausea , headache , vomiting , and dizziness . Mean increases in heart rate and blood pressure were observed , and were consistent with the AE profile in adults with FM . Conclusions The open-label findings provide preliminary evidence that milnacipran may improve symptoms of JFM , with a safety and tolerability profile that is consistent with the experience in adult FM patients . Future trial design s for JFM should consider the relatively low recognition of this condition compared to adult FM and the difficulties with enrollment . Trial registration NCT01328002 ; The aim of this study was to evaluate the effectiveness of aerobic exercise in water pool compared with aerobic exercise performed in sea by women with fibromyalgia ( FM ) . A total of 46 patients were r and omly allocated into two groups : pool group ( 23 patients ) and sea group ( 23 patients ) that performed the same aerobic exercise program . Patients were evaluated baseline and after 12 weeks using : VAS , number of tender points , FIQ , SF-36 , PSQI , and BDI . Both groups improved significantly in post-treatment for all the evaluated variables . There were no significant differences between two groups , except for BDI ( F = 2.418 , P < 0.0001 ) . Aerobic exercise program performed in water ( pool or sea ) was effective for patients with FM . However , sea water exercises have been shown to bring more advantages related to emotional aspects . Then , exercise performed sea water ( thalassotherapy ) is an option for effective treatment with low cost for patients with FM INTRODUCTION The importance of physical exercise for patients with fibromyalgia ( FM ) is very clear in the literature . Dancing is a type of aerobic exercise that has great acceptance . In addition to the beneficial effects of aerobic exercise , Zumba works on motor coordination and also has socializing as a part that should be included in patients with fibromyalgia . OBJECTIVES To evaluate the effectiveness of Zumba dancing in improving pain , functional capacity , quality of sleep and quality of life of women with fibromyalgia . DESIGN A pre-post treatment design . METHODS We evaluated 19 women with fibromyalgia , selected by convenience . Data were collected in the second half of 2016 . Zumba dancing was performed twice a week for 12 weeks . Patients were evaluated at week 0 ( T0 ) and at week 12 ( T12 ) , by the following instruments : VAS ( Visual Analogic Scale ) , Likert Scale , TUG ( Timed Up an Go Test ) , 6MWT ( Six-minute Walk Test ) , FIQ ( Fibromyalgia Impact Question naire ) , PSQI ( Pittsburgh Sleep Quality Index ) , ESS ( Epworth Sleepiness Scale ) and SF-36 quality of life . RESULTS We found differences in pain ( VAST0 = 6.21 and VAST12 = 4.53 ) with p = 0.001 and in the domain physical functioning of SF36 ( T0 = 42.37 and T12 = 52.11 ) with p = 0.04 . No differences were found for the other variables between the times . CONCLUSION Zumba dancing as a form of treatment for three months for patients with fibromyalgia was effective in improving pain and physical functioning . Future controlled and r and omized clinical trials should be performed to improve the evidence of Zumba dancing in women with fibromyalgia OBJECTIVE To examine the effectiveness of a supervised aerobic exercise program , a self-management education program , and the combination of exercise and education for women with fibromyalgia ( FM ) . METHODS One hundred fifty-two women were r and omized into one of 4 groups : exercise-only , education-only , exercise and education , or control . The duration of the study was 12 weeks . All subjects were analyzed at 3 times : before study , immediately upon completion , and 3 months after completion of the intervention program on measures of disability , self-efficacy , fitness , tender point count , and tender point tenderness .  Of the 152 women , complete data were available for 95 and 69 who complied with the protocol . In order to determine the group time interaction , a 2 way analysis of variance with repeated measures was used for each measure . RESULTS The only significant group time interaction was reported with the compliance analysis for the Self-Efficacy Coping with Other Symptoms subscale and the Six Minute Walk . If the program was followed , the combination of a supervised exercise program and group education provided persons with FM with a better sense of control over their symptoms . Fitness improved in the 2 groups undergoing supervised aerobic exercise programs . However , the improvement in fitness was maintained at followup in the exercise-only group and not the combined group . Conclusion . Subjects receiving the combination of exercise and education and who complied with the treatment protocol improved their perceived ability to cope with other symptoms . In addition , a supervised exercise program increased walking distance at post-test , an increase that was maintained at followup in the exercise-only group . Results demonstrate the challenges with conducting exercise and education studies in persons with FM Objective The aim of this study was to compare pool-based exercise and balneotherapy in fibromyalgia syndrome ( FMS ) patients . Methods Fifty female patients diagnosed with FMS according to the American College of Rheumatism ( ACR ) criteria were r and omly assigned to two groups : group 1 ( n=25 ) with pool-based exercise , and in group 2 ( n=25 ) balneotherapy was applied in the same pool without any exercise for 35 min three times a week for 12 weeks . In both groups , pre- ( week 0 ) and post-treatment ( weeks 12 and 24 ) evaluation was performed by one of the authors , who was blind to the patient group . Evaluation parameters included pain , morning stiffness , sleep , tender points , global evaluation by the patient and the physician , fibromyalgia impact question naire , chair test , and Beck depression inventory . Statistical analysis was done on data collected from three evaluation stages . Results Twenty-four exercise and 22 balneotherapy patients completed the study . Pretreatment ( week 0 ) measurements did not show any difference between the groups . In group 1 , statistically significant improvement was observed in all parameters ( P<0.01 ) except for the chair test at both weeks 12 and 24 . In group 2 , week 12 measurements showed significant improvement in all parameters ( P<0.01 ) except for the chair test and Beck depression inventory . Week 24 evaluation results in group 2 showed significant improvements in pain and fatigue according to visual analogue scale ( VAS ) , 5-point scale , number of tender points , algometric and myalgic scores , and patient and physician global evaluation ( P<0.01 and P<0.05 , respectively ) , while improvements were nonsignificant in morning stiffness , sleep , fibromyalgia impact question naire ( FIQ ) , chair test , and Beck depression inventory parameters in this group . Comparison of the two groups based on the post-treatment ( weeks 12 and 24 ) percent changes and difference scores relative to pretreatment ( week 0 ) values failed to show a significant difference between the groups for any parameter except Beck depression inventory ( P<0.01 ) . Conclusion The results of our study showed that pool-based exercise had a longer-lasting effect on some of the FMS symptoms , but statistical analysis failed to show a significant superiority of pool-based exercise over balneotherapy without exercise . While we believe that exercise is a gold st and ard in FMS treatment , we also suggest in light of our results that balneotherapy is among the valid treatment options in FMS , and further research regarding the type and duration of the exercise programs is necessary UNLABELLED Despite promising preliminary results in treating fibromyalgia ( FM ) pain , no neuromodulation technique has been adopted in clinical practice because of limited efficacy , low response rate , or poor tolerability . This phase II open-label trial aims to define a methodology for a clinical ly effective treatment of pain in FM by establishing treatment protocol s and screening procedures to maximize efficacy and response rate . High-definition transcranial direct current stimulation ( HD-tDCS ) provides targeted subthreshold brain stimulation , combining tolerability with specificity . We aim ed to establish the number of HD-tDCS sessions required to achieve a 50 % FM pain reduction , and to characterize the biometrics of the response , including brain network activation pain scores of contact heat-evoked potentials . We report a clinical ly significant benefit of a 50 % pain reduction in half ( n = 7 ) of the patients ( N = 14 ) , with responders and nonresponders alike benefiting from a cumulative effect of treatment , reflected in significant pain reduction ( P = .035 ) as well as improved quality of life ( P = .001 ) over time . We also report an aggregate 6-week response rate of 50 % of patients and estimate 15 as the median number of HD-tDCS sessions to reach clinical ly meaningful outcomes . The methodology for a pivotal FM neuromodulation clinical trial with individualized treatment is thus supported . ONLINE REGISTRATION Registered in Clinical trials.gov under registry number NCT01842009 . PERSPECTIVE In this article , an optimized protocol for the treatment of fibromyalgia pain with targeted subthreshold brain stimulation using high-definition transcranial direct current stimulation is outlined BACKGROUND This pilot study was design ed to test the efficacy of a physical activity program for improving psychological variables and fibromyalgia syndrome ( FMS ) symptoms and to provide preliminary evidence regarding the effects on perceived cognitive symptoms and objective ly measured cognitive performance by FMS patients . METHODS Sixteen women diagnosed with FMS were r and omly assigned to an 18-week physical activity program or to a control condition .  Psychological measures , FMS symptoms , perceived cognitive function , objective measures of cognition , and walking capacity were assessed at baseline and posttest . RESULTS At posttest , there were significant differences in fatigue ( effect size , ES=1.86 ) , depression ( ES=1.27 ) , FMS symptoms ( ES=1.56 ) , self-reported cognitive symptoms ( ES=1.19 ) , and delayed recall performance ( ES=1.16 ) between the physically active group and the control group , indicating that the FMS patients benefited from physical activity . Beneficial effects were also observed for 6 of the 7 objective measures of cognition and ranged from small to large ( ESs=0.26 to 1.06 ) . CONCLUSIONS Given that all FMS patients do not respond well to conventional treatments , these beneficial effects of physical activity are important . Future studies with larger sample s are warranted to test the reliability of the findings for the objective measures of cognition Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors . To date , most research has focused on post-treatment interventions . However , given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment , and that the effects are substantially more pronounced during treatment , an assessment of the safety and efficacy of exercise during treatment is warranted . In this review , we present and evaluate the results of r and omized controlled trials ( RCTs ) conducted during breast cancer treatment . We conducted literature search es to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation .  Data were extracted on physiological and psychosocial outcomes . Cohen 's d effect sizes were calculated for each outcome . A total of 17 studies involving 1,175 participants undergoing active cancer therapy met the inclusion criteria . Findings revealed that , on average , exercise interventions result ed in moderate to large improvements in muscular strength : resistance exercise ( RE , 𝑑 = 0.86 ) , aerobic exercise  ( AE , 𝑑 = 0.55 ) , small to moderate improvements in cardiovascular functioning ( RE , 𝑑 = 0.45 ; AE , 𝑑 = 0.17 , combination exercise ( COMB , 𝑑 = 0.31 ) and quality of life ( QoL ; RE , 𝑑 = 0.30 ; AE , 𝑑 = 0.50 ; COMB , 𝑑 = 0.63 ) . The results of this review suggest that exercise is a safe , feasible , and efficacious intervention in breast cancer patients who are undergoing different types of treatment . Additional research addressing the different modes of exercise during each type of treatment is warranted to assess the comparable efficacy of the various exercise modes during established breast cancer treatments BACKGROUND Self-management has increasingly been recommended as part of st and ard care for fibromyalgia , a common , poorly understood condition with limited treatment options . Data that assess popular self-management recommendations are scarce . We evaluated and compared the effectiveness of 4 common self-management treatments on function , symptoms , and self-efficacy in women with fibromyalgia . METHODS A total of 207 women with confirmed fibromyalgia were recruited from September 16 , 2002 , through November 30 , 2004 , and r and omly assigned to 16 weeks of ( 1 ) aerobic and flexibility exercise ( AE ) ; ( 2 ) strength training , aerobic , and flexibility exercise ( ST ) ; ( 3 ) the Fibromyalgia Self-Help Course ( FSHC ) ; or ( 4 ) a combination of ST and FSHC ( ST-FSHC ) . The primary outcome was change in physical function from baseline to completion of the intervention . Secondary outcomes included social and emotional function , symptoms , and self-efficacy . RESULTS Improvements in the mean Fibromyalgia Impact Question naire score in the 4 groups were -12.7 for the ST-FSHC group , -8.2 for the AE group , -6.6 for the ST group , and -0.3 for the FSHC group . The ST-FSHC group demonstrated greater improvement than the FSHC group ( mean difference , -12.4 ; 95 % confidence interval [ CI ] , -23.1 to -1.7 ) . The ST-FSHC ( mean difference , 13.6 ; 95 % CI , 2.3 to 24.9 ) and AE ( mean difference , 13.1 ; 95 % CI , 1.6 to 25.6 ) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey . Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC ( 14.8 ) , AE ( 13.2 ) , and ST ( 5.7 ) groups . Social function , mental health , fatigue , depression , and self-efficacy also improved . The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months . CONCLUSIONS Progressive walking , simple strength training movements , and stretching activities improve functional status , key symptoms , and self-efficacy in women with fibromyalgia actively being treated with medication . The benefits of exercise are enhanced when combined with targeted self-management education . Our findings suggest that appropriate exercise and patient education be included in the treatment of fibromyalgia OBJECTIVES Group exercises may be useful in fibromyalgia syndrome ( FMS ) .  The ' Body movement and perception ' ( BMP ) method is based on low impact exercises , awareness of body perception and relaxation , aim ed at treating small groups of patients following the Resseguier method ( RM ) and integrating RM with exercises derived from soft gymnastics . We assessed the effects of BMP method on FMS . METHODS 40 women with FMS ( age and disease duration : 51.7±7.2 and 4.9±3.8 years ) participated in an open pilot study . BMP sessions were performer twice a week ( 50 minutes each ) for 8 weeks . Patients were assessed at enrolment ( T0 ) and at the end of the study ( T1 ) by a self-administered question naire ( temporal characteristics of pain , pain interference in working and recreational activities and in night-time rest , awareness of pain , fatigue , irritability , well-being , quality of movement , ability to focus on perception and to perceive whole body , postural selfcontrol , ability to relax ) and a clinical evaluation ( tender points , assumption of analgesics/NSAIDs , distribution of pain , pain in sitting and st and ing position , pain during postural passages and gait , postural body alignment , muscular contractures ) . RESULTS At T1 , FMS patients significantly improved with respect to T0 in pain , fatigue , irritability , well-being , quality of movement , postural self-control , ability to relax mind and body , movement perception , tender point scores , assumption of analgesic/NSAIDs , body alignment and muscle contractures ( p<0.05 for all the comparisons T1 versus T0 ) . CONCLUSIONS In FMS patients , rehabilitation with BMP  improves pain and well being , reduces the number of tender points and muscle contractures , thus it is useful in FMS management Abstract Introduction Fibromyalgia ( FM ) is characterized by chronic pain . Impaired growth hormone responses and reduced serum insulin-like growth factor 1 ( IGF-1 ) are common in FM . The aim was to examine changes in serum IGF-1 , cerebrospinal fluid ( CSF ) , neuropeptides , and cytokines during aerobic exercise in FM patients . Methods In total , 49 patients ( median age , 52 years ) with FM were included in the study . They were r and omized to either the  moderate- to high-intensity Nordic Walking ( NW ) program  ( n = 26 ) or the  supervised low-intensity walking ( LIW ) program  ( n = 23 ) . Patients participated in blood tests before and after 15 weeks of aerobic exercise .  Changes in serum levels of free IGF-1 , pain rating on a 0- to 100-mm scale , pain threshold , and 6-minute walk test ( 6MWT ) were examined . CSF , neuropeptides , matrix metalloproteinase 3 ( MMP-3 ) , and inflammatory cytokines were determined . Nonparametric tests were used for group comparisons and correlation analyses . Results Serum free IGF-1 levels did not change during 15 weeks of exercise between the two groups , although the 6MWT significantly improved in the NW group ( p = 0.033 ) when compared with LIW . Pain did not significantly change in any of the groups , but tended to decrease ( p = 0.052 ) over time in the total group . A tendency toward a correlation was noted between baseline IGF-1 and a decrease of pain in response to exercise ( r = 0.278 ; p = 0.059 ) . When adjusted for age , this tendency disappeared . The change in serum free IGF-1 correlated positively with an alteration in CSF substance P ( SP ) levels ( rs= 0.495 ; p = 0.072 ) , neuropeptide Y ( NPY ) ( rs = 0.802 ; p = 0.001 ) , and pain threshold ( rs = 0.276 ; p = 0.058 ) . Differing CSF SP levels correlated positively to a change in pain threshold ( rs= 0.600 ; p = 0.023 ) , whereas the shift in CSF MMP-3 inversely correlated with an altered pain threshold ( rs= -0.569 ; p = 0.034 ) . Conclusions The baseline level of serum free IGF-1 did not change during high or low intensity of aerobic exercise . Changes in IGF-1 correlated positively with a variation in CSF SP , NPY , and pain threshold . These data indicate a beneficial role of IGF-1 during exercise in FM.Trial registration : Clinical Trials.gov NCT00643006 STUDY DESIGN Single-subject , multiple-baseline design across 3 subjects . OBJECTIVE To investigate the use of a quota-based approach to prescribing a walking program for individuals with fibromyalgia ( FM ) . BACKGROUND Exercise has been found to be beneficial for individuals with FM . What has not been determined is the best way to implement an exercise program that does not increase FM symptoms . METHODS AND MEASURES Three women with FM were r and omly assigned a baseline period of 5 , 6 , or 7 weeks , which served as the control phase , followed by an intervention period consisting of an 8-week walking program . The walking program progression was prescribed using a quota-based approach . Weekly outcome measures were the Fibromyalgia Impact Question naire ( FIQ ) , Arthritis Self-Efficacy Scale ( ASES ) , and SF-36v2 ( acute ) . A 6-minute walk test was recorded twice : at the start of the baseline phase ( after a trial phase ) and at the end of the intervention phase . RESULTS Subjects 1 and 3 had a significant decrease in the symptoms associated with FM during the intervention phase ( FIQ , P<.05 ) , but no significant increase in self-efficacy ( ASES ) . They increased their walking distances used for exercise by 640 and 480 m , respectively . Subject 2 had no significant improvements in her symptoms of FM . Despite a significant decrease in ASES ( P<.05 ) , walking distance used for exercise by subject 2 increased by 2080 m. Six-minute walk test distances increased 76 , 32 , and 106 m for subjects 1 , 2 , and 3 , respectively . CONCLUSIONS Prescribing a walking program using a quota-based exercise prescription result ed in increasing the distance walked for 3 subjects . It also decreased symptoms associated with FM in 2 of the 3 subjects , but did not increase self-efficacy 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 design ed 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 systematic ally 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 OBJECTIVE To analyze the long-term efficacy of 2 interventions for female fibromyalgia ( FM ) patients : 1 ) cognitive-behavioral therapy ( CBT ) , and 2 ) a physical exercise (PE)-based strategy . METHODS We conducted a prospect i ve , long-term , r and omized , parallel clinical trial . The outcome variables are physical activity , aerobic capacity , and results of the Fibromyalgia Impact Question naire ( FIQ ) , Short Form 36 , Beck Anxiety and Depression Inventory , Chronic Pain Self-Efficacy Scale , and Chronic Pain Coping Inventory . All were measured at baseline , posttreatment , 6 months , and 1 year . The duration of both treatments was 8 weeks . RESULTS Some items of the FIQ and some strategies to cope with pain improved significantly in both groups after treatment . All variables measuring functional capacity improved significantly in the PE group , whereas only physical activity of the vertebral column improved in the CBT group . There were no differences in anxiety , depression , and self efficacy after treatment in either group . After 1 year of followup , most of the parameters had returned to baseline values in both groups . However , in the PE group , functional capacity remained significantly better . CONCLUSIONS PE and CBT improve clinical manifestations in FM patients only for short periods of time . Improvement in self efficacy and physical fitness are not associated with improvement in clinical manifestations BACKGROUND Exercise therapy is an effective component of fibromyalgia ( FM ) treatment . However , it is important to know the effects and specificities of the different types of exercise : muscle stretching and resistance training . AIM To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients . DESIGN R and omized controlled trial . SETTING Physical therapy service , FM outpatient clinic . POPULATION Forty-four women with FM ( 79 screened ) . METHODS Patients were r and omly allocated into a stretching group ( N.=14 ) , resistance group ( N.=16 ) , and control group ( N.=14 ) . Pain was assessed using the visual analog scale , pain threshold using a Fischer dolorimeter , FM symptoms using the Fibromyalgia Impact Question naire ( FIQ ) , and quality of life using the Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36 ) . The three intervention groups continued with usual medical treatment . In addition , the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks . RESULTS After treatment , the stretching group showed the highest SF-36 physical functioning score ( P=0.01 ) and the lowest bodily pain score ( P=0.01 ) . The resistance group had the lowest FIQ depression score ( P=0.02 ) . The control group had the highest score for FIQ morning tiredness and stiffness , and the lowest score for SF-36 vitality . In clinical analyses , the stretching group had significant improvement in quality of life for all SF-36 domains , and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning , vitality , social function , emotional role , and mental health . CONCLUSIONS Muscle stretching exercise was the most effective modality in improving quality of life , especially with regard to physical functioning and pain , and resistance training was the most effective modality in reducing depression . CLINICAL REHABILITATION IMPACT The trial included a control group and two intervention groups , both of which received exercise programs created specifically for patients with FM . In clinical practice , we suggest including both modalities in an exercise therapy program for FM OBJECTIVE To examine the effectiveness of concurrent strength and endurance training on muscle strength , aerobic and functional performance , and symptoms in postmenopausal women with fibromyalgia ( FM ) . DESIGN R and omized controlled trial . SETTING Local gym and university research laboratory . PARTICIPANTS Twenty-six women with FM . INTERVENTION Progressive and supervised 21-week concurrent strength and endurance training . MAIN OUTCOME MEASURES Muscle strength of leg extensors , upper extremities , and trunk ; peak oxygen uptake ( Vo(2)peak ) , maximal workload ( Wmax ) , and work time ; 10-m walking and 10-step stair-climbing time and self-reported functional capacity ( Health Assessment Question naire ) ; and symptoms of FM . RESULTS After concurrent strength and endurance training , the groups differed significantly in Wmax ( P=.001 ) , work time ( P=.001 ) , concentric leg extension force ( P=.043 ) , walking ( P=.001 ) and stair-climbing ( P<.001 ) time , and fatigue ( P=.038 ) . The training led to an increase of 10 % ( P=.004 ) in Wmax and 13 % ( P=.004 ) in work time on the bicycle but no change in Vo(2)peak . CONCLUSIONS Concurrent strength and endurance training in low to moderate volume improves the muscle strength of leg extensors , Wmax , work time , and functional performance as well as perceived symptoms , fatigue in particular . Concurrent strength and endurance training is beneficial to postmenopausal women with FM without adversities , but more extensive studies are needed to confirm the results Objectives : Cognitive-behavioral therapies ( CBT ) for fibromyalgia syndrome ( FMS ) are important interventions in the management of this condition . Empirical evidence reports that although the results are promising , further research is needed to respond more appropriately to these patients . This study focuses on exploring the use of Virtual Reality ( VR ) as an adjunct to the activity management component . The aim of this study is to present the results of a small-sized r and omized controlled trial to test the preliminary efficacy and acceptability of this component . Material s and Methods : The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology . The sample was r and omly allocated to 2 conditions : VR treatment and treatment as usual . Results : Participants in the VR condition achieved significant improvements in the primary outcome : disability measured with the FIQ . The improvement was also significant in secondary outcomes , such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory : task persistence and exercise . There were no differences in other secondary outcome measures like pain intensity and interference and depression . Participants reported high satisfaction with the VR component . Discussion : The effects were related to the psychological aspects targeted in the treatment . The component was well accepted by FMS patients referred from a public hospital . These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS OBJECTIVE Fibromyalgia syndrome ( FMS ) is a chronic rheumatological condition which could be characterized by generalized pain and fatigue . Cognitive and behavioral therapy has been found to be a suitable technique in the management of FMS . This study intends to evaluate the efficacy of electromyography ( EMG ) biofeedback to reduce pain in patients with FMS . MATERIAL S AND METHODS A r and omized controlled trial involving two groups of FMS patients , one receiving EMG biofeedback and the other a sham biofeedback  , was carried out . The assessment tools included in the study were fibromyalgia impact question naire ( FIQ ) , visual analogue scale ( VAS ) , six-minute walk test ( SMWT ) and number of tender points ; and tenderness of each tender point was done for both the groups . STATISTICS A Student 's ' t ' test was used to study the test for significance . RESULTS After using biofeedback , the mean VAS scores and the mean number of tender points were found to be 3 out of 10 and 6 out of 18 respectively . Subjective analysis from both groups showed improvement in physical and psychological realms . Statistical significance . CONCLUSION Biofeedback as a treatment modality reduces pain in patients with FMS , along with improvements in FIQ , SMWT and the number of tender points OBJECTIVE To compare the clinical effectiveness of aerobic exercise in the water with walking/jogging for women with fibromyalgia ( FM ) . METHODS Sixty sedentary women with FM , ages 18 - 60 years , were r and omly assigned to either deep water running ( DWR ) or l and -based exercises ( LBE ) . Patients were trained for 15 weeks at their anaerobic threshold .  Visual analog scale of pain , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory , Short Form 36 Health Survey ( SF-36 ) , and a patient 's global assessment of response to therapy ( PGART ) were measured at baseline , week 8 , and week 15 . Statistical analysis included all patients . RESULTS Four patients dropped out from each group . Both groups improved significantly at week 15 compared with baseline , with an average 36 % reduction in pain intensity . For PGART , 40 % of the DWR group and 30 % of the LBE group answered " much better " at posttreatment . FIQ total score and FIQ depression improvements in the DWR group were faster ( week 8) than the LBE group and kept improving ( week 15 ; P < 0.05 ) . Only the DWR group showed improvements in SF-36 role emotional ( P = 0.006 ) . No significant between-group differences were observed for peak oxygen uptake and other outcomes . CONCLUSION DWR is a safe exercise that has been shown to be as effective as LBE regarding pain . However , it has been shown to bring more advantages related to emotional aspects . Aerobic gain was similar for both groups , regardless of symptom improvement . Therefore , DWR could be studied as an exercise option for patients with FM who have problems adapting to LBE or lower limbs limitations Fibromyalgia syndrome ( FMS ) is a chronic disorder that is characterized by widespread pain with localized tenderness . We aim ed to investigate whether thermal therapy combining sauna therapy and underwater exercise improved pain , symptoms , and quality of life ( QOL ) in FMS patients . Forty-four female FMS patients who fulfilled the American College of Rheumatology ( ACR ) criteria received 12-week thermal therapy program comprising sauna therapy once daily for 3 days/week and underwater exercise once daily for 2 days/week . Pain , symptoms , and QOL were assessed using a pain visual analog scale ( VAS ) , a fibromyalgia impact question naire ( FIQ ) , and a short form 36-item question naire ( SF-36 ) , respectively . All of the patients reported significant reductions in pain and symptoms of 31 - 77 % after the 12-week thermal therapy program , which remained relatively stable ( 28 - 68 % ) during the 6-month follow-up period ( that is , the thermal therapy program improved both the short-term and the long-term VAS and FIQ scores ) . Improvements were also observed in the SF-36 score .  Thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients Background Fibromyalgia ( FM ) , one of the most common musculoskeletal disorders , is associated with high levels of impaired health and inadequate or limited symptom relief . The cause of this complex syndrome is unknown , and there is no known cure . Numerous research results indicate that a combination of physical exercise and mind-body therapy is effective in symptom management .  T’ai Chi , an ancient Chinese exercise , combines physical exercise with mind-body therapy . Purpose To investigate the effects of T’ai Chi exercise on FM symptoms and health-related quality of life . Design Pilot study , one group pre-to-post posttest design . Methods Participants with FM ( n = 39 ) formed a single group for 6 weeks of 1-hour , twice weekly T’ai Chi exercise classes .  FM symptoms and health-related quality of life were measured before and after exercise . Findings Twenty-one participants completed at least 10 of the 12 exercise sessions . Although the dropout rate was higher than expected , measurements on both the Fibromyalgia Impact Question naire ( FIQ ) ( Buckhardt , Clark , & Bennett , 1991 ) and the Short Form-36 ( SF-36 ) ( Ware & Sherbourne , 1992 ) revealed statistically significant improvement in symptom management and health-related quality of life . Implication s for Nursing Research Knowledge of interventions to enhance health for the patient with musculoskeletal problems is a National Association of Orthopaedic Nurses priority . T’ai Chi is potentially beneficial to patients with FM . Further research is needed to support evidence -based practice The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia . Thirty women with fibromyalgia were r and omized to either an aerobic exercise ( AE ) program or a strengthening exercise ( SE ) program for 8 weeks . Outcome measures included the intensity of fibromyalgia-related symptoms , tender point count , fitness ( 6-min walk distance ) , hospital anxiety and depression ( HAD ) scale , and short-form health survey ( SF-36 ) . There were significant improvements in both groups regarding pain , sleep , fatigue , tender point count , and fitness after treatment . HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores . Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group , whereas seven subscales of SF-36 , physical component summary , and mental component summary improved significantly in the SE group . When the groups were compared after treatment , there were no significant differences in pain , sleep , fatigue , tender point count , fitness , HAD scores , and SF-36 scores . AE and SE are similarly effective at improving symptoms , tender point count , fitness , depression , and quality of life in fibromyalgia OBJECTIVE It is a traditional practice in the Alpine region of Trentino and Alto Adige ( Italy ) to use phytothermotherapeutic treatment with fermenting grass ( " hay baths " ) for rheumatic diseases . However , despite its long history and popularity , a clinical validation of the efficacy and tolerability of the treatment has yet to be found in current literature . Fibromyalgia syndrome ( FMS ) is characterised by generalised musculoskeletal pain , high tender point counts , sleep disturbance , fatigue , headaches , irritable bowel syndrome , frequent psychological distress and depressed mood . There is no st and ard therapy regime for FMS and the variety of medical treatments used have given limited benefits . The aim of this study was to assess the efficacy and tolerability of a cycle of phytothermotherapy through a single-blind , controlled , r and omised trial , in patients with primary FMS . METHODS Fifty-six patients with primary FMS according to the ACR criteria were r and omly allocated to two groups : 30 were su bmi tted to phytothermotherapy at the thermal resort of Garniga Terme ( Trento , Italy ) and the other 26 were considered as controls . All patients were evaluated by FIQ , Tender Points Count , HAQ and AIMS 1 at baseline , after 10 days , then after 12 and 24 weeks . RESULTS Patients su bmi tted to phytothermotherapy showed visible and significant improvement of all evaluation parameters at the end of the treatment , which persisted during the follow-up period . No significant difference was found in the control group . Regarding the tolerability , none of the patients presented side effects . CONCLUSIONS Our results suggest the efficacy and the tolerability of phytothermotherapy in patients with primary FMS To determine and compare short- and long-term effects of aerobic exercise ( AE ) , stress management treatment ( SMT ) , and treatment-as-usual ( TAU ) in fibromyalgia , 60 patients were r and omized to 14 weeks of treatment by either AE , SMT or TAU . Outcome measures at baseline , midway through treatment , at treatment completion , and at 4 year follow up included a patient made drawing of pain distribution , dolorimetry of tender points , ergometer cycle test , global subjective improvement , and VAS registration s of : pain , disturbed sleep , lack of energy , and depression . Both AE and SMT showed positive short-term effects .  AE was the overall most effective treatment , despite being subject to the most sceptical patient attitude prior to the study . At follow up , there were no obvious group differences in symptom severity , which for AE seemed to be due to a considerable compliance problem Abstract : Fibromyalgia ( FM ) is a disorder characterised by diffuse widespread musculoskeletal aching and stiffness and multiple tender points [ 1 ] . Its pathophysiology is poorly understood . The influence of aerobic endurance exercise on pain in patients with FM was investigated . Twenty-seven patients ( 25 female , 2 male ) participated in a controlled clinical study and performed 12 weeks of jogging , walking , cycling or swimming following a given schedule .  Twelve sedentary FM patients ( 11 female , 1 male ) served as controls . Before and after training both the study and the control groups were evaluated spiroergometrically .  Tender point pain was quantified by dolorimetry . The painful body surface was estimated by a pain body diagram , and its intensity by a visual analogue scale and a ranking scale . Patients trained for an average of 25 min two to three times a week , with an average intensity of 50 % of maximal oxygen uptake ( VO2max ) . Unlike the control group , the training group exhibited a decrease in heart rate and VO2 and an increase in respiratory quotient during submaximal workload . Maximal performance capacity and VO2max remained unchanged , whereas the wattpulse ( watt/heart rate ) improved at maximal workload . Pain parameters remained unchanged in the control group , but in the training group the mean number of positive tender points ( 15.4/12.7 ) , the mean pain threshold of the gluteal tender point ( 2.89 kp/3.50 kp ) and the painful body surface ( 18%/15 % body surface ) decreased significantly . Subjective general pain condition deteriorated in two patients but improved in 17 . Our results suggest a positive effect of aerobic endurance exercise on fitness and well-being in patients with FM Summary In patients with fibromyalgia syndrome , we investigated the effects of adequately optimized serum calcifediol levels on their perception of pain , health‐related quality of life , and comorbidities . ABSTRACT The role of calcifediol in the perception of chronic pain is a widely discussed subject . Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome ( FMS ) . We lack evidence of the role of vitamin D supplementation in these patients . To our knowledge , no r and omized controlled trial has been published on the subject . Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria , with serum calcifediol levels < 32 ng/mL ( 80 nmol/L ) , were r and omized to treatment group ( TG ) or control group ( CG ) . The goal was to achieve serum calcifediol levels between 32 and 48 ng/mL for 20 weeks via oral supplementation with cholecalciferol . The CG received placebo medication . Re‐evaluation was performed in both groups after a further 24 weeks without cholecalciferol supplementation . The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain ( visual analog scale score ) . Additional variables were evaluated using the Short Form Health Survey 36 , the Hospital Anxiety and Depression Scale , the Fibromyalgia Impact Question naire , and the Somatization subscale of Symptom Checklist‐90‐Revised . A marked reduction in pain was noted over the treatment period in TG : a 2 ( groups ) × 4 ( time points ) variance analysis showed a significant group effect in visual analog scale scores . This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36 . Optimization of calcifediol levels in FMS had a positive effect on the perception of pain . This economical therapy with a low side effect profile may well be considered in patients with FMS . However , further studies with larger patient numbers are needed to prove the hypothesis OBJECTIVES We determined -- in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume , pain , physical performance , and physical function . DESIGN This was a r and omized clinical trial comparing 024 essential oil with sham oil combined with exercise . SETTING S SETTING S included community sites in southern California . SUBJECTS The study included 20 women r and omized to 024 oil , 23 to sham oil .  INTERVENTIONS Women were trained in oil application before exercise , at bedtime on exercise days ; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen ( allowing choice of program level ) plus 2 days of home exercise with the recorded regimen . OUTCOME MEASURES Primary : Exercise volume ( number of days exercised multiplied by exercise level -- intensity and duration ) . Secondary : Pain ( Brief Pain Inventory ) , measures of physical performance ( 30-second chair st and s , 6-minute walk , multidimensional balance ) , and self-reported physical function ( Composite Physical Function scale ) . RESULTS The average participant was 54 years old , had some college education , was married , Caucasian , and minimally/mildly depressed . There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks ( depression as covariate ) . There were no significant group nor pre- to postexercise changes in pain intensity or interference . There were greater positive changes in 30-second chair st and s , 6-minute walk distance , and multidimensional balance scores in the 024 group than in the sham group , but these were not significant . The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume ( frequency , exercise level -- intensity and duration ) for women with FM . It is unknown whether 024 actually decreases local pain when used with exercise . CONCLUSIONS Increases in physical function found , while not significant , may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen Fibromyalgia ( FM ) is a nonarticular rheumatological syndrome associated with diverse clinical and psychological features . One of the major complaints in FM is reduced pain tolerance , especially in tender points ( TP ) for which patients derive significant benefit from nonsteroidal antiinflammatory drugs or corticosteroids .  Patients with FM also have altered reactivity of the hypothalamic pituitary adrenal ( HPA ) axis where the predominant feature is reduced containment of the stress response system through diminished adrenocortical output and feedback resistance . Our results show that mud packs together with antidepressant treatment are able to influence the HPA axis , stimulating increased levels of adrenocorticotropic hormone , cortisol and beta-endorphin serum levels . The discharge of corticoids in the blood and the increase in beta-endorphin serum levels are followed by a reduction in pain symptoms , which is closely related to an improvement in disability , depression and quality of life . It seems that the synergic association between a pharmacological treatment ( trazodone ) and mud packs acts by helping the physiological responses to achieve homeostasis and to rebalance the stress response system . To clarify and optimize the effectiveness of this synergic association , studies involving a larger number of FM patients and a different pharmacological treatment are needed The optimal exercise modality for reductions of abdominal obesity and risk factors for  type 2 diabetes in youth is unknown . We examined the effects of aerobic exercise ( AE ) versus resistance exercise ( RE ) without caloric restriction on abdominal adiposity , ectopic fat , and insulin sensitivity and secretion in youth . Forty-five obese adolescent boys were r and omly assigned to one of three 3-month interventions : AE , RE , or a nonexercising control . Abdominal fat was assessed by magnetic resonance imaging , and intrahepatic lipid and intramyocellular lipid were assessed by proton magnetic resonance spectroscopy . Insulin sensitivity and secretion were evaluated by a 3-h hyperinsulinemic-euglycemic clamp and a 2-h hyperglycemic clamp . Both AE and RE prevented the significant weight gain that was observed in controls . Compared with controls , significant reductions in total and visceral fat and intrahepatic lipid were observed in both exercise groups . Compared with controls , a significant improvement in insulin sensitivity ( 27 % ) was observed in the RE group . Collapsed across groups , changes in visceral fat were associated with changes in intrahepatic lipid ( r = 0.72 ) and insulin sensitivity ( r = −0.47 ) . Both AE and RE alone are effective for reducing abdominal fat and intrahepatic lipid in obese adolescent boys . RE but not AE is also associated with significant improvements in insulin sensitivity PURPOSE To determine the effect of submaximal steady-state exercise on cognitive performance in patients with chronic fatigue syndrome ( CFS ) alone , CFS with comorbid fibromyalgia FM ( CFS + FM ) , and sedentary healthy controls ( CON ) . METHODS Twenty CFS-only patients , 19 CFS + FM , and 26 CON completed a battery of cognitive tests design ed to assess speed of information processing , variability , and efficiency .  Tests were performed at baseline , immediately before , and twice following 25 min of either cycle ergometry set at 40 % of peak oxygen capacity or quiet rest . RESULTS There were no group differences in average percentage of peak oxygen consumption during exercise ( CFS = 45 % ; CFS + FM = 47 % ; Control = 43 % : P = 0.2 ) . There were no significant effects of acute exercise on cognitive performance for any group . At baseline , one-way ANOVA indicated that CFS patients displayed deficits in speed of processing , performance variability , and task efficiency during several cognitive tests compared with healthy controls . However , the CFS + FM patients were not different than controls . Repeated measures ANOVA indicated that across all tests ( pre- and postexercise ) CFS , but not CFS + FM , were significantly less consistent ( F2,59 = 3.7 , P = 0.03 ) and less efficient ( F2,59 = 4.6 , P = 0.01 ) than controls . CONCLUSION CFS patients without comorbid FM exhibit subtle cognitive deficits in terms of speed , consistency , and efficiency that are not improved or exacerbated by light exercise . Importantly , our data suggest that CFS + FM patients do not exhibit cognitive deficits either pre- or postexercise . These results highlight the importance of disease heterogeneity in studies determining acute exercise and cognitive function in CFS OBJECTIVES In fibromyalgia syndrome ( FMS ) defined rehabilitation guidelines are yet to be vali date d. Our aim is to evaluate the efficacy of the Rességuier method ( RM ) in FMS . METHODS Forty-one patients were r and omly assigned to Interventional ( 22 pts ) and Observational ( 19 pts ) Group ( IG and OG ) . The study lasted 8 months . Patients were assessed at baseline ( T0 ) after a 2-month rehabilitation ( T1 ) and at a 6-month follow-up ( T2 ) ( only IG ) with SF-36 Physical ( PSI ) and Mental Synthetic Index ( MSI ) , Regional Pain Scale ( RPS ) , Fibromyalgia Impact Question naire ( FIQ ) , Number Rating Scales 0 - 10 to measure pain , movement quality , sleep , relax ability , analgesics number/per week . OG patients maintained their lifestyle for the duration of the study . RM aims to obtain patient awareness and control of bodily perceptions , thus reaching a modulation of responses to pain . Therapist controls patient attention and perception by verbal and manual contacts and leads them to perform bodily and respiratory active and conscious movements . RESULTS In IG , at T1 all items were improved : PSI and MSI ( p<0.001 and = 0.001 ) , FIQ ( p<0.0001 ) , RPS ( p<0.001 ) , pain ( p<0.0001 ) , movement quality ( p=0.001 ) , relax ability ( p<0.0001 ) , sleep ( p<0.001 ) ; analgesics number/per week was reduced ( p<0.001 ) . All results obtained at T1 , except FIQ , were maintained at T2 . In OG at T1 versus T0 , no difference in any of the assessed parameters was observed . CONCLUSION In FMS patients , the rehabilitation with RM  improves HRQoL , FMS-related disability and perceived pain , thus reducing the assumption of analgesics OBJECTIVE To measure , and seek clinical correlates with , levels of  substance P ( SP ) in the cerebrospinal fluid ( CSF ) of fibromyalgia syndrome ( FMS ) patients . METHODS CSF from 32 FMS patients and 30 normal control subjects was tested for SP by radioimmunoassay . Clinical measures included tender point examination and st and ardized question naires . RESULTS CSF SP levels were 3-fold higher in FMS patients than in normal controls ( P < 0.001 ) , but they correlated only weakly with tenderness found on examination . CONCLUSION SP is significantly elevated in FMS CSF , but other abnormalities must exist in FMS to more fully explain the symptoms Introduction The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking ( NW ) on functional capacity and pain in fibromyalgia ( FM ) . Methods A total of 67 women with FM were recruited to the study and r and omized either to moderate-to-high intensity Nordic Walking ( n = 34 , age 48 ± 7.8 years ) or to a control group engaging in supervised low-intensity walking ( LIW , n = 33 , age 50 ± 7.6 years ) . Primary outcomes were the six-minute walk test ( 6MWT ) and the Fibromyalgia Impact Question naire Pain scale ( FIQ Pain ) . Secondary outcomes were : exercise heart rate in a submaximal ergometer bicycle test , the FIQ Physical ( activity limitations ) and the FIQ total score . Results A total of 58 patients completed the post-test . Significantly greater improvement in the 6MWT was found in the NW group ( P = 0.009 ) , as compared with the LIW group . No between-group difference was found for the FIQ Pain ( P = 0.626 ) . A significantly larger decrease in exercise heart rate ( P = 0.020 ) and significantly improved scores on the FIQ Physical ( P = 0.027 ) were found in the NW group as compared with the LIW group . No between-group difference was found for the change in the FIQ total . The effect sizes were moderate for the above mentioned outcomes . Conclusions Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise , result ing in improved functional capacity and a decreased level of activity limitations . Pain severity did not change over time during the exercise period . Trial registration Clinical trials.gov identifier NCT00643006 OBJECTIVE To evaluate the safety and efficacy of sodium oxybate for management of the symptoms of fibromyalgia syndrome ( FMS ) . METHODS Patients with FMS ( according to the American College of Rheumatology 1990 criteria ) were r and omized , after discontinuing their pre study medications for FMS , to receive 4.5 gm or 6 gm of sodium oxybate or matching placebo once per night for 8 weeks . The primary outcome variable ( POV ) was a composite score for changes from baseline in 3 co primary self-report measures : patient 's pain rating ( in daily electronic diaries ) on a visual analog scale ( PVAS ) , the Fibromyalgia Impact Question naire ( FIQ ) score , and the Patient Global Impression of Change ( PGI-C ) . A beneficial response rate for the POV composite score was defined as > or=20 % improvement in the PVAS and FIQ scores plus a rating of " much better " or " very much better " on the PGI-C. Secondary measures included subjective sleep outcomes ( on the Jenkins Scale for Sleep ) and quality -of-life measures . The analyses were based on an intent-to-treat ( ITT ) population . RESULTS The ITT population included 188 patients with FMS , 78 % of whom completed the trial . Significant benefit was observed with both dosages of sodium oxybate , according to changes in the POV and subjective sleep quality . Improvements in the PVAS score were significantly correlated with sleep outcomes . Sodium oxybate was well tolerated overall ; dose-related nausea ( < or=28 % of patients ) and dizziness ( < or=18 % of patients ) tended to resolve with continued therapy . CONCLUSION Sodium oxybate therapy was well tolerated and significantly improved the symptoms of FMS . Further study of sodium oxybate as a novel therapeutic option for FMS is warranted
Pain was significantly reduced post treatment by l and -based and water-based AE , exercises with slight to moderate intensity and frequency of two or three times per week .
Positive effects on depressed mood , HRQOL and physical fitness could be maintained at follow-up .
Continuing exercise was associated with positive outcomes at follow-up .
Introduction The efficacy and the optimal type and volume of aerobic exercise ( AE ) in fibromyalgia syndrome ( FMS ) are not established .
We therefore assessed the efficacy of different types and volumes of AE in FMS .