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Title: Exercise Helps In Fibromyalgia Despite Initial Pain

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BMJ 2002; 325:185-187.
07/25/2002 07:02:00 PM
By Harvey McConnell

A series of controlled graded aerobic exercise is a simple, cheap, and effective treatment for patients with fibromyalgia. A major problem at the beginning of an exercise program is convincing patients it will work because they suffer initial increases in pain and stiffness immediately after exercise. This may convince many patients at the beginning that exercise will worsen their condition, warns Dr Selwyn Richards and colleagues at the Department of Rheumatology at Poole Hospital, Poole, Dorset, England. Conventional medical treatment of fibromyalgia with analgesics, non-steroidal anti-inflammatory drugs, and antidepressants is relatively ineffective, the clinicians said. Several randomized controlled trials of exercise therapy in fibromyalgia produced generally positive results, but were under-powered, excluded many cases, and were supervised in hospitals by highly experienced healthcare professionals. One hundred and thirty two men and women with fibromyalgia, selected from an initial population of 7,806 patients attending the hospital rheumatology clinic, were enrolled over a one year period into a randomized controlled trial. The patients were randomly assigned to either aerobic exercise classes or relaxation classes, twice weekly for 12 weeks. Classes were carried out by personal trainers with no special experience in providing exercise for people with ill health. The clinicians then gauged results based on the men and women who reported on their improvement, plus tender point count, impact of condition measured by fibromyalgia impact questionnaire, and short form McGill pain questionnaire. The exercise program, when compared with the relaxation program, led to significantly more men and women rating themselves as much, or very much, better at three months. These benefits were maintained, or even improved in some patients, when they were assessed a year later, especially the fall in tender point counts. The researchers said exercise treatment has limitations, especially with compliance by the men and women when they suffer pain after beginning the exercise program. "Future strategies to increase the efficacy of exercise as an intervention should confront the issue of compliance," they conclude.

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