Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review Aerobic fitness effects in fibromyalgia. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. Strengthening Exercises Improve Symptoms and Quality of Life but Do Not Change Autonomic Modulation in Fibromyalgia: A Randomized Clinical Trial Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial.
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 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 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 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 determine the effectiveness of a muscle strengthening program compared to a stretching program in women with fibromyalgia ( FM ) . METHODS Sixty-eight women with FM were r and omly assigned to a 12 week , twice weekly exercise program consisting of either muscle strengthening or stretching . Outcome measures included muscle strength ( main outcome variable ) , flexibility , weight , body fat , tender point count , and disease and symptom severity scales . RESULTS No statistically significant differences between groups were found on independent t tests . Paired t tests revealed twice the number of significant improvements in the strengthening group compared to the stretching group . Effect size scores indicated that the magnitude of change was generally greater in the strengthening group than the stretching group . CONCLUSION Patients with FM can engage in a specially tailored muscle strengthening program and experience an improvement in overall disease activity , without a significant exercise induced flare in pain . Flexibility training alone also results in overall improvements , albeit of a lesser degree Objective Autonomic dysfunction is an important mechanism that could explain many symptoms observed in fibromyalgia ( FM ) .  Exercise is an effective treatment , with benefits potentially mediated through changes in autonomic modulation . Strengthening is one of the less studied exercises in FM , and the acute and chronic effects of strengthening on the autonomic system remain unknown . The objective of this study was to assess the chronic effects of strengthening exercises ( STRE ) on autonomic modulation , pain perception and the quality of life ( QOL ) of FM patients . Methods Eighty sedentary women with FM ( ACR 1990 ) were r and omly selected to participate in STRE or flexibility ( FLEX ) exercises in a blinded controlled trial . The intensity of STRE was set at 45 % of the estimated load of 1 Repetition Maximum ( RM ) in 12 different exercises . Outcomes were Visual Analog Scale ( VAS ) for pain , Heart Rate Variability ( HRV ) analysis , treadmill test , the sit and reach test ( Wells and Dillon ’s Bench ) , maximal repetitions test and h and grip dynamometry ; and quality of life by the Fibromyalgia Impact Question naire ( FIQ ) , the Beck and I date Trait-State Inventory ( I DATE ) , a short-form health survey ( SF-36 ) . Results The STRE group was more effective to strength gain for all muscles and pain control after 4 and 16 weeks ( p<0.05 ) . The FLEX group showed higher improvements in anxiety ( p<0.05 ) . Both groups showed improvements in the QOL , and there was no significant difference observed between the groups . There was no change in the HRV of the STRE and FLEX groups . Conclusions Strengthening exercises show greater and more rapid improvements in pain and strength than flexibility exercises . Despite the benefits in fitness , pain , depression , anxiety and quality of life , no effect was observed on the autonomic modulation in both groups . This observation suggests that changes in autonomic modulation are not a target tobe clinical ly achieved in fibromyalgia . Trial Registration Clinical Trials.gov 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
There is ' gold ' level evidence ( www.cochranemsk.org ) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms .
Strength training may also have benefits on some FMS symptoms .
BACKGROUND Fibromyalgia ( FMS ) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services .
Exercise training is commonly recommended as a treatment .
This is an up date of a review published in Issue 2 , 2002 .
OBJECTIVES The primary objective of this systematic review was to evaluate the effects of exercise training including cardiorespiratory ( aerobic ) , muscle strengthening , and /or flexibility exercise on global well-being , selected signs and symptoms , and physical function in individuals with FMS .