The aim of this study was to compare pool-based exercise and balneotherapy in fibromyalgia syndrome (FMS) patients.
Fifty female patients diagnosed with FMS according to the American College of Rheumatism (ACR) criteria were randomly assigned to two groups: group 1 (n=25) with pool-based exercise, and in group 2 (n=25) balneotherapy was applied in the same pool without any exercise for 35 min three times a week for 12 weeks. In both groups, pre- (week 0) and post-treatment (weeks 12 and 24) evaluation was performed by one of the authors, who was blind to the patient group. Evaluation parameters included pain, morning stiffness, sleep, tender points, global evaluation by the patient and the physician, fibromyalgia impact questionnaire, chair test, and Beck depression inventory. Statistical analysis was done on data collected from three evaluation stages.
Twenty-four exercise and 22 balneotherapy patients completed the study. Pretreatment (week 0) measurements did not show any difference between the groups. In group 1, statistically significant improvement was observed in all parameters (P<0.01) except for the chair test at both weeks 12 and 24. In group 2, week 12 measurements showed significant improvement in all parameters (P<0.01) except for the chair test and Beck depression inventory. Week 24 evaluation results in group 2 showed significant improvements in pain and fatigue according to visual analogue scale (VAS), 5-point scale, number of tender points, algometric and myalgic scores, and patient and physician global evaluation (P<0.01 and P<0.05, respectively), while improvements were nonsignificant in morning stiffness, sleep, fibromyalgia impact questionnaire (FIQ), chair test, and Beck depression inventory parameters in this group. Comparison of the two groups based on the post-treatment (weeks 12 and 24) percent changes and difference scores relative to pretreatment (week 0) values failed to show a significant difference between the groups for any parameter except Beck depression inventory (P<0.01).
The results of our study showed that pool-based exercise had a longer-lasting effect on some of the FMS symptoms, but statistical analysis failed to show a significant superiority of pool-based exercise over balneotherapy without exercise. While we believe that exercise is a gold standard in FMS treatment, we also suggest in light of our results that balneotherapy is among the valid treatment options in FMS, and further research regarding the type and duration of the exercise programs is necessary.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Bennett RM (1989) Fibrositis. In: Kelly WN, Harris ED, Ruddy S, Sledge CB (eds) Textbook of rheumatology. Saunders, Philadelphia, pp 541–550
Wolfe F (1996) The fibromyalgia syndrome: a consensus report on fibromyalgia and disability. J Rheumatol 23:534–539
Meiworm L, Jakop E, Walker UA, Peter HH, Keul J (2000) Patients with fibromyalgia benefit from aerobic endurance exercise. Clin Rheumatol 19:253–257
Martin L, Nutting A, Macintosh BR, Edworthy SM, Butterwick D, Cook J (1996) An exercise program in the treatment of fibromyalgia. J Rheumatol 23:1050–1053
Clark SR, Jones KD, Burckhardt CS, Bennet R (2001) Exercise for patient with fibromyalgia: risks versus benefits. Curr Rheumatol Rep 3:135–146
Gowans SE, deHueck A, Voss S, Richardson M (1999) A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res 12:120–128
Mannerkopi K, Nyberg B, Ahlmen M, Ekdahl C (2000) Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol 27:2473–2481
Jentoft ES, Kvalvik AG, Mengshoel AM (2001) Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis Rheum 45:42–47
Sukenik S, Buskila D, Neuman L, Kleiner-Baumgarten A, Zimlichman RS, Horowitz J (1990) Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea area. Ann Rheum Dis 49:99–102
Sukenik S, Flusser D, Abu-Shakra (1999) The role of spa therapy in various rheumatic disease. Rheum Dis North Am 25:883–897
Yurtkuran M, Yurtkuran MA, Dilek K, Güllülü M, Karakoç Y, Özbek L et al (1999) A randomized, controlled study of balneotherapy in patients with rheumatoid arthritis. Phys Rehab Kur Med 9:92–96
Sukenik S, Baradin R, Codish S, Neumann L, Flusser D, Abu-Shakra M et al (2001) Balneotherapy at the Dead Sea area for patients with psoriatic arthritis and concomitant fibromyalgia. IMAJ 3:147–150
Neumann L, Sukenik S, Bolotin M, Abu-Shakra M, Amir M, Flusser D et al (2001)The effect of balneotherapy at the Dead Sea on the quality of life of patients with fibromyalgia syndrome. Clin Rheumatol 20:15–19
Evcik D, Kızılay B, Gökçen E (2002) The effect of balneotherapy on fibromyalgia patients. Rheumatol Int 22:103–106
Yurtkuran M, Çeliktaş M (1996) A randomized, controlled trial of balneotherapy in the treatment of patients with primary fibromyalgia syndrome. Phys Rehab Kur Med 6:109–112
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 33:160–172
Williams BW (1978) A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatr 45:742–747
Fisher AA (1986) Pressure threshold meter: its use for quantification of tender spots. Arch Phys Med Rehabil 67:836–838
Tunks E, McCain GA, Hart LE, Teasell RW, Goldsmith CH, Rollman GB et al (1995) The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls. J Rheumatol 22:944–952
Hewett JE, Buckelew SP, Johnson JC, Shaw SE, Huyser B, Fu YZ (1995) Selection of measures suitable for evaluating change in fibromyalgia clinical trials. J Rheumatol 22:953–958
Burckhardt CS, Clark SR, Bennett RM (1991) The Fibromyalgia Impact Questionnaire: development and validation. J Rheumatol 18:728–733
Mannerkopi K, Svantesson U, Carlsson J, Ekdahl C (1999)Tests of functional limitations in fibromyalgia syndrome: a reliability study. Artritis Care Res 12:193–199
Goldenberg DL (1989) Psyciatric and psychologic aspects of fibromyalgia syndrome. Rheum Dis North Am 15:105–114
Moldofsky H, Scarisbrick P (1976) Induction of neurasthenic musculoskeletal pain syndrome by selsctive sleep stage deprivation. Psychosom Med 38:35–44
Bennett RM, Clark S, Goldberg L, Nelson D, Bonafede RP, Porter J et al (1989) Aerobic fitness in the fibrositis syndrome. A controlled study of respiratory gas exchange and xenon 133 clearence from exercising muscle. Arthritis Rheum 32:454–460
Wong R, Lopaschuk G, Zhu G, Walker D, Catellier D, Burton D et al (1992) Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy. Chest 102:1716–1722
Ramsay C, Moreland J, Ho M, Joyce S, Walker S, Pullar T (2000) An observer-blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Rheumatology 39:501–505
Koltyn KF (2000) Analgesia following exercise. A review. Sports Med 29:85–98
Kjaer M (1992) Regulation of hormonal and metabolic responses during exercise in humans. Exerc Sport Sci Rev 20:161–184
Drewes AM, Andreasen A, Schroder HD, Hogsaa B, Jennum P (1993) Pathology of skeletal muscle in fibromyalgia: a histo-immuno-chemical and ultrastructural study. Br J Rheumatol 32:479–483
Sharpio CM, Bortz R, Mitchell D, Bartel P, Jooste P (1981) Slow-wawe sleep: a recovery period after exercise. Science 214:1253–1254
Gowans SE, de Hueck A, Voss S, Silaj A, Abbey SE, Reynolds WJ (2001) Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis Rheum 45:519–529
Ahmadi J, Samavatt F, Sayyad M, Ghanizadeh A (2002) Various types of exercise and scores on the Beck Depression Inventory. Psychol Rep 90:821–822
Meeusen R, De Meirleir K (1995) Exercise and brain neurotransmission. Sports Med 20:160–188
Buskila D, Abu-Sharka M, Neumann L, Odes L, Shneider E, Flusser D et al (2001) Balneotherapy for fibromyalgia at the Dead Sea. Rheumatol Int 20:105–108
Karagülle Z, Dönmez A (2002) Letter to the editors. Rheumatol Int 21:210–211
Lehmann JE (1990) Diathermy and superficial heat, laser and cold therapy. In: Kottke EJ, Lehmann JE (eds) Krusen's handbook of physical medicine and rehabilitation. Saunders, Philadelphia
Jezova D, Vigas M, Tatar P, Jurcovicova J, Palat M (1985) Rise in plasma β-endorphin and ACTH in response to hyperthermia in sauna. Horm Metab Res 17:693–694
Yurtkuran M, Ulus H, İrdesel J (1993) The effect of balneotherapy on the plasma-endorphine level in patients with osteoarthritis. Phys Rehab Cur Med 3:130–132
The authors would like to thank Özgür Ünlü for her help in statistical analyses and Nilgün Keren, Serpil Korkmaz, and Demet Zengin for their help in patient care and technical assistance.
About this article
Cite this article
Altan, L., Bingöl, U., Aykaç, M. et al. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int 24, 272–277 (2004). https://doi.org/10.1007/s00296-003-0371-7