Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Exercise and Fibromyalgia: It Really Works, Sort Of

The better-than-nothing approach

For years the fibromyalgia patient has been told to exercise as part of the approach to at least modulate the intensity of the chronic pain. The patients usually dismiss these sometimes desperate exercise entreaties, often walking away thinking that there must be something more to the treatment of chronic, pervasive pain than a stroll around the block.

However, the inclusion of exercise in the array of prescriptions given the fibromyalgia patient gained some significant support in the form of a Cochrane Collaboration review recently made public. After an extensive analysis of the published literature on the subject of exercise and fibromyalgia, these reviewers concluded that resistance training was both beneficial and safe for women with fibromyalgia, and that aerobic exercise does indeed lessen the pain associated with fibromyalgia.

Alas, as often is the case with good news, a caveat: These conclusions were supported by evidence of less than ideal quality. After all, it would be difficult to perform a randomized, double-blind study of walking around the block or lifting weights: It is pretty obvious to the subject that he or she is walking or pumping iron.

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The studies included 219 women with fibromyalgia, 95 of whom were assigned to resistance training programs. Three trials compared 16 to 21 weeks of moderate- to high- intensity training with a control group. Two studies compared eight weeks of progressive resistance training with aerobic training. One study compared 12 weeks of low-intensity training with flexibility exercise.

Nonetheless, the findings are what the findings are: moderate- to high-intensity resistance training improved multidimensional function, pain, tenderness, and muscle strength in women with fibromyalgia. And aerobic exercise was superior to moderate-intensity resistance training for improving pain in women with fibromyalgia. While the reduction in pain was noted with aerobic exercise when compared with resistance training, no significant differences between these two exercise approaches were noted in multidimensional function, self-reported physical function, or tenderness. Resistance training was more effective than a flexibility exercise regimen for multidimensional function and pain, but did not significantly impact tenderness or strength.

There were no serious adverse effects reported for any of these exercise modalities, but there were also no overwhelmingly positive treatment effects appreciated.

Somehow I believe fibromyalgia patients have heard that line more than once in their dealings with the health care profession.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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