"Another Fibromyalgia & Exercise Study. Sigh." by Adrienne Dellwo

[Tom Kindlon]

"Another Fibromyalgia & Exercise Study. Sigh." by Adrienne Dellwo:

I think most people with fibromyalgia get sick of seeing these studies on how exercise makes us better. The latest onehas me shaking my head a bit.​

continues at:​

http://chronicfatigue.about.com/b/2013/06/11/another-fibromyalgia-exercise-study-sigh.htm

 

[Tom Kindlon]

Here's the abstract for the particular paper. But her comments are more general than this one paper.

Original Article

Moderate-vigorous physical activity improves long-term clinical outcomes without worsening pain in fibromyalgia

Anthony S. Kaleth PhD1,†,*,
Chandan K. Saha PhD2,
Mark P. Jensen PhD3,
James E. Slaven MS2,
Dennis C. Ang MD, MS4

DOI: 10.1002/acr.21980

Issue

Arthritis Care & Research


Abstract

Objective:

To evaluate the relationship between long-term maintenance of moderate-vigorous physical activity (MVPA) and clinical outcomes in fibromyalgia (FM).

Methods:

Patients with FM (n=170) received individualized exercise prescriptions and completed baseline and follow-up physical activity assessments using the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire at weeks 12, 24, and 36.

The primary outcome was the change in the Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI) score.

Secondary outcomes included improvements in overall well-being (FIQ-Total), pain severity ratings, and depression.

Results:

Using a threshold increase in MVPA of ≥10 metabolic equivalent hours per week (MET h/wk) above usual activities, 27 subjects (15.9%) increased and sustained (SUS-PA), 68 (40%) increased, but then declined (UNSUS-PA), and 75 (44.1%) did not achieve this benchmark (LO-PA).

Compared to LO-PA subjects, both SUS-PA and UNSUS-PA subjects reported greater improvement in FIQ-PI (p<0.01) and FIQ-Total (p<0.05).

Additionally, the SUS-PA group reported greater improvement in pain severity compared to the LO-PA group (p<0.05).

However, there were no significant group differences between SUS-PA and UNSUS-PA for any primary or secondary outcome measure.

Conclusion:

Increased participation in MVPA for at least 12 weeks improves physical function and overall well-being in patients with FM.

Although sustained physical activity was not associated with greater clinical benefit compared to unsustained physical activity, these findings also suggest that performing greater volumes of physical activity is not associated with worsening pain in FM.

Future research is needed to determine the relationship between sustained MVPA participation and subsequent improvement in patient outcomes.

 

[Tom Kindlon]

I'm not up-to-date with the Fibromyalgia literature. Fibromyalgia seems to be heterogeneous and I suspect some don't have the exercise problems seen in ME/CFS.

Anyway, here's an extract from my paper:

5.4 Monitor intervention implementation and compliance using objective measures of activity

[..]

Documenting the type of, intensity of, and frequency of exercise/activity sessions in GE/GA programs is also needed. When assessing the safety of pharmaceuticals, dosage is important: a drug may be safe at one dosage but quite dangerous at a higher dosage. There seems to be no reason to view GE and GA differently. For example, a pilot study by Meyer et al. of high- and low-intensity exercise for fibromyalgia, a condition that has considerable overlap in symptomatology with ME/CFS (158,159), required participants to complete and post weekly activity logs (160). An examination of the returns found very poor compliance with the assigned exercise programs, leading the researchers to reassign participants to the high- and low- intensity groups based on the actual activity levels recorded in their logs. Interestingly they found that there was a difference (p<0.05) between the groups on the Fibromyalgia Impact Questionnaire, with scores improving from baseline in the low-intensity exercise group but deteriorating in those who had performed high intensity exercise.

from:

Kindlon T. Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Bulletin of the IACFS/ME. 2011;19(2):59-111
Free at: http://iacfsme.org/BULLETINFALL2011/Fall2011KindlonHarmsPaperABSTRACT/tabid/501/Default.aspx

 

[maryb]

Add a double 'sigh' from me............

 

[A.B.]

15.9% of the time it works every time.

 

[Mya Symons]

Who are these people with Fibromyalgia who can exercise moderately vigorously (whatever that means) without increasing their pain? I have tried to do this more than once. Always, that night, and for several days later, I end up feeling like I got the crap beaten out of me (that's not counting the fatigue and flu). I know several people with FMS. I have never met anyone who feels better after vigorous exercise (even moderately vigorous:thumbdown . Amazing!


On this: "Although sustained physical activity was not associated with greater clinical benefit compared to unsustained physical activity, these findings also suggest that performing greater volumes of physical activity is not associated with worsening pain in FM."

Huh?! WTH?

 

[WillowJ]

Using a threshold increase in MVPA of ≥10 metabolic equivalent hours per week (MET h/wk) above usual activities, 27 subjects (15.9%) increased and sustained (SUS-PA), 68 (40%) increased, but then declined (UNSUS-PA), and 75 (44.1%) did not achieve this benchmark (LO-PA).

Compared to LO-PA subjects, both SUS-PA and UNSUS-PA subjects reported greater improvement in FIQ-PI (p<0.01) and FIQ-Total (p<0.05).

hmm, maybe the low activity group didn't do exercise or improve because... they were more ill? just a thought.

Additionally, the SUS-PA group reported greater improvement in pain severity compared to the LO-PA group (p<0.05).

However, there were no significant group differences between SUS-PA and UNSUS-PA for any primary or secondary outcome measure.

The primary outcome was the change in the Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI) score.

Secondary outcomes included improvements in overall well-being (FIQ-Total), pain severity ratings, and depression.

so, exercise improved pain severity but did not improve pain severity? that's very curious. Also exercise did not significantly impact physical function, well-being, or depression. usually it's claimed this will do all 4.

Increased participation in MVPA for at least 12 weeks improves physical function and overall well-being in patients with FM.

this appears to be totally unsupported and gratuitous according to the information in the abstract.

 

[WillowJ]

Fibromyalgia Impact Questionnaire (FIQ):
http://www.rheumatology.org/Practice/Clinical/Clinicianresearchers/Outcomes_Instrumentation/Fibromyalgia_Impact_Questionnaire_(FIQ)/


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745803/

 

[Shell]

I'm fast coming to the conclusion that a whole truck load of supposedly peer reviewed studies and research is nothing more than snake oil. I can't tell whether it's just lack of integrity or education that's the problem. I'm afraid I am beginning to think it's both.

How many people with a dx of FMS have no comorbidities?
How many people with a dx of FMS find that ADLs alone can cause a crash? Surely I am not the only one?
If just getting through ADLs can make a person ill - how in the name of the corpse of common sense is extra exercise going to help?
If there are a group of people with mild FMS and nothing else who find that exercise helps them - well good for them. But to extrapolate from that the idea that all PWFMS should try it, is simply barmy.

 

[Lotus97]

A friend with fibromyalgia just told me she got a job and also started working out. I really do hope everything goes well for her, but I'm still concerned. I'm confused though about how they determine the difference between FMS and CFS/ME. The symptoms list for each illness is practically the same. For that matter, the symptoms list of Lyme is pretty similar too except that the neurological symptoms of Lyme are less likely (but not completely unheard of). Someone did post a study comparing mitochondrial function of FMS and CFS/ME so I guess they do have a way (I didn't read the study), but even if there is a way to differentiate between the two illnesses my guess is that most doctors don't know the difference.

 

[Dolphin]

I've just read the full paper.
It makes no mention of sub-grouping/heterogeneity within the FMS construct. Given only 15.9% sustained increased activity and sustained the increase, this statement shouldn't apply to the other 83.1%:

Although sustained physical activity was not associated with greater clinical benefit compared to unsustained physical activity, these findings also suggest that performing greater volumes of physical activity is not associated with worsening pain in FM.

 

[Dolphin]

From the Introduction:

Among the people that begin physical activity programs, long-term adherence is often suboptimal and frequently associated with a worsening of FM symptoms (11).

11. Ramsay C, Moreland J, Ho M, Joyce S, Walker S, Pullar T. An observer-blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Rheumatology (Oxford) 2000;39:501–5.

Although most exercise trials have reported clinical benefits in FM, the majority of these studies have not evaluated the long-term sustainability of these benefits (i.e.,
12 weeks).

From discussion, for what it's worth:

Finally, we cannot rule out the possibility that some subjects may have overestimated their level of physical activity. A previous study has indicated that
60% of adults who do not currently meet recommended PA guidelines overestimate their physical activity levels (32).

32. Van Sluijs EM, Griffin SJ, van Poppel MN. A cross-sectional study of awareness of physical activity: associations with personal, behavioral and psychosocial factors. Int J Behav Nutr Phys Act 2007;4:53.