One-year follow-up shows sustained benefits from aerobic exercise in fibromyalgia

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One-year follow-up shows sustained benefits from aerobic exercise in

fibromyalgia

Dec 22, 2004 Janis

Toronto, ON - A 1-year follow up of fibromyalgia (FM) patients who had

participated in a 23-week aerobic exercise program found that exercise

improved physical function, mood, symptom severity, and aspects of

self-efficacy for at least 12 months [1]. The study was published in the

December 15, 2004 issue of Arthritis & Rheumatism.

The sustained improvements in physical function appear to require

ongoing exercise at follow-up. The improvements in mood do not.

" Physical function (6-minute-walk test) and mood (Beck Depression Inventory

[bDI]) remained significantly and clinically improved in our uncontrolled

1-year follow-up of a 6-month aerobic exercise program. The sustained

improvements in physical function appear to require ongoing exercise at

follow-up. The improvements in mood do not, " lead author Dr Sue E Gowans

(University Health Network, Toronto, ON) tells rheumawire.

Study population included broad sample of FM patients

Gowans et al had conducted a randomized controlled trial on the effects of

23 weeks of supervised aerobic exercise classes on physical function and

mood in fibromyalgia patients [2]. Subjects in the controlled trial who were

randomized to exercise participated in 30-minute exercise classes 3 times

per week. Each class included 10 minutes of stretching and 20 minutes of

aerobic exercise.

" This study is noteworthy since it was conducted with a mix of patients from

a tertiary care center and the community. We also had a high level of

baseline depression in our sample. Both of these factors are important

because fibromyalgia severity is known to be higher in patients seen in

tertiary care centers (and therefore potentially more recalcitrant), and

other exercise studies have specifically excluded patients with high levels

of depression (again because of the worry that symptoms of these patients

are more recalcitrant), " Gowans says.

One-year follow-up shows continued improvements in mood, physical function

The current report is an uncontrolled 1-year follow-up that examined

outcomes in 29 subjects. Efficacy analyses were based on 18 subjects. The 11

who were excluded from efficacy analysis included 4 who changed potential

mood-altering medications during the exercise study, 2 who received

professional treatment for stress, and 5 who attended less than 45% of the

exercise classes. Primary outcomes were the Beck Depression Inventory to

assess mood and the 6-minute-walk test to assess physical function.

Secondary outcomes included the state version of the State-Trait Anxiety

Inventory (STAI), the Fibromyalgia Impact Questionnaire (FIQ), the Arthritis

Self-Efficacy Scale, and the number of tender points.

After the initial 23-week program, subjects continued unsupervised exercise.

Continuing exercise compliance was measured as 2 simple dichotomous

variables, depending on whether the subject had exercised in the preceding 2

weeks and also on whether the subject had exercised for at least 90 minutes

in the preceding week. The third measure of exercise compliance, exercise

duration at follow-up, was the total minutes of exercise/week at each of the

6-month and 12-month follow-up points. Two thirds of patients reported some

level of continued exercise, and slightly less than half reported exercising

at least 90 minutes per week at the 1-year follow-up.

The investigators found that " 23 weeks of exercise can produce significant

improvements in physical function and mood for up to 12 months following the

end of supervised exercise classes. " Improvements were larger and more

likely to be clinically significant in the patients who continued to

exercise. For example, 6-minute-walk distances were +55 m to +57 m and

average BDI total scores changed from " moderately depressed " to " mildly

depressed " in patients who continued to exercise.

Exercise duration at follow-up was related to improvements in 6-minute-walk

distances at both follow-up points, suggesting that continued exercise is

necessary for sustaining these improvements.

In contrast, the improvements in depression at 6- and 12-months were

similar, but only improvements at 6 months were related to exercise

duration. Gowans says that this might mean that " at some point between 6 and

12 months, ongoing exercise was not required to maintain mood gains. "

There was no change in the number of tender points, either at the end of the

23-week exercise program or at either the 6-month or 12-month follow-up.

" The improvements in function and mood occurred in the absence of any

improvement in tender-point count (although perhaps tender points would have

improved if we measured them with a [more sensitive] myalgia score vs a

simple tender-point count), " Gowans says.

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