Effects of different types of exercises on pain, quality of life, depression, and body composition in women with fibromyalgia: 2022 Kolak et al

Abstract

Objectives: This study aims to compare the efficacy of three different exercise types on pain, health-related quality of life (HRQoL), depression, and body composition in women with fibromyalgia (FM).

Patients and methods: Between June 2019 and December 2019, a total of 41 women with FM (mean age: 46.7+9.4 years; range, 24 to 62 years) were randomly allocated into Group 1 (n=13, supervised aerobic plus stretching), Group 2 (n=13, supervised resistance plus stretching), and Group 3 (n=15, home-based stretching). All exercises were performed three times per week for 12 weeks and were individualized by measuring the maximal oxygen consumption (VO2max) for aerobic exercise and one-repetition maximum (1-RM) test for resistance exercise. The main measures were pain intensity assessed by the Visual Analog Scale (VAS), severity by the Fibromyalgia Impact Questionnaire (FIQ), symptoms of depression by the Beck Depression Inventory, HRQoL by the Short-Form Health Questionnaire (SF-36), and body composition by bioelectrical impedance analysis.

Results: The mean VAS difference (95% confidence interval [CI]): -2.61 (-1.94, -3.29); -2.61 (-1.82, -3.42); -1.07 (-0.49, -1.64) for Group 1, Group 2, and Group 3, respectively (p<0.001); however, there was no significant difference between the combined exercise groups. The FIQ scores decreased significantly in all exercise groups after training (p<0.05). At 12 weeks, 21 (80.8%) patients from combined groups and six (40%) patients from the stretching alone group achieved a minimal clinically significant difference defined as a 14% change in baseline FIQ scores (p=0.008). Other outcome parameters did not differ significantly among the groups.

Conclusion: Supervised aerobics/muscle strengthening combined with stretching exercises reduced pain, and FM severity more than a home stretching exercise alone.

Open access, https://archivesofrheumatology.org/full-text/1350

 

All bolding is mine.

Small study. Initially 84 subjects randomized into three groups and at the end, only 41 participants remained.

"...This study aims to compare the efficacy of three different exercise types on pain, health-related quality of life (HRQoL), depression, and body composition in women with fibromyalgia (FM)."

My complaint is here with the muscle strengthening protocol:

"... An exercise prescription was developed for each woman based on the data acquired from the one-repetition maximum (1-RM) test. The participants were instructed to perform their exercises with 50% of 1-RM for six weeks. In the seventh week, weights were increased to 70 to 80% of 1-RM. The number of sets increased progressively (in the first two weeks, one set of 10 repetitions; at Weeks 3 and 4, two sets of 10 repetitions; at Weeks 5 and 6, three sets of 10 repetitions). "

So the participants established the maximum weight they could lift and then 50% of that weight was used, first at 10 reps, and increasing to 2 sets of 10 reps, 3 sets of 10 reps and then by the 7th week (out of 12, the weight itself was increased to 70-80% of their maximum one time weight lift.

They noted that this strengthening regimen using weights resulted in no increase in pain. I find this point hard to believe. My only explanation is that the subjects had very mild FM or were not suffering FM at all (there is a purported nearly 30% misdiagnosis generally).

No doubt there is some placebo effect of pleasing the researchers in the data capture.

Also, the socializing effect of being in a group exercise program would most certainly affect scores on various instruments (scales used). Also, the study duration is 12 weeks. FM flares come and go and are not only due to physical activity, but also cold weather, weather changes, interpersonal stress. A better look would take a year's worth of data and exercise.

They used the Fibromyalgia Impact Questionnaire (Turkish version) instead of the more recent FIQ-Revised*. This may or may not have significance.

Limitations of the study:

"...The limitations of this study are as follows: lack of a non-exercise control group, and lack of follow-up after the intervention. Additionally, only women were included in the study, as FM predominantly affects women. The CPET after a 12-week exercise could not be performed due to unpreventable restrictions caused by the novel coronavirus disease 2019 (COVID-19) pandemic. Since VO2max measurement values were not an outcome measure, we only used them as an evaluation parameter in prescribing aerobic exercise. The pre-training values of VO2max helped us to demonstrate statistical indifference among groups; however, the post-exercise change can also be evaluated by further studies."

*Here is a link to the FIQ-R https://arthritis-research.biomedcentral.com/articles/10.1186/ar2783/tables/1