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Exercise for patients with fibromyalgia: Risks versus benefits

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Abstract

Although exercise in the form of stretching, strength maintenance, and aerobic conditioning is generally considered beneficial to patients with fibromyalgia (FM), there is no reliable evidence to explain why exercise should help alleviate the primary symptom of FM, namely pain. Study results are varied and do not provide a uniform consensus that exercise is beneficial or what type, intensity, or duration of exercise is best. Patients who suffer from exercise-induced pain often do not follow through with recommendations. Evidence-based prescriptions are usually inadequate because most are based on methods designed for persons without FM and, therefore, lack individualization. A mismatch between exercise intensity and level of conditioning may trigger a classic neuroendocrine stress reaction. This review considers the adverse and beneficial effects of exercise. It also provides a patient guide to exercise that takes into account the risks and benefits of exercise for persons with FM.

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References and Recommended Reading

  1. Bennett RM: Fibromyalgia. In Textbook of Pain. Edited by Wall PD, Melzack R. Churchill Livingstone; 1999:579–600. Comprehensive review of pathophysiology and treatment of fibromyalgia.

  2. Jones KD: A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. Oregon Health Sciences University, 2000. The only study to isolate two of the three major components of a fitness program by comparing muscle strengthening to flexibility training. Demonstrated that patients with fibromyalgia could take part in a specially tailored muscle-strengthening program and experience an improvement in overall disease activity, without a significant exercise-induced flare-up in pain.

  3. Elert JE, Rantapäa Dahlqvist SB, Henriksson-Larsen K, Gerdle B: Increased EMG activity during short pauses in patients with primary fibromyalgia. Scand J Rheumatol 1989, 18:321–323.

    PubMed  CAS  Google Scholar 

  4. Isomeri R, Mikkelsson M, Latikka P: Effects of amitriptyline and cardiovascular fitness training on the pain of fibromyalgia patients. Scand J Rheumatol 2000, Suppl 94:47.

    Google Scholar 

  5. Nichols DS, Glenn TM: Effects of aerobic exercise on pain perception, affect, and level of disability in individuals with fibromyalgia. Physical Therapy 1994, 74(4):329–49 54/332.

    Google Scholar 

  6. Martin L, Nutting A, MacIntosh BR, Edworthy SM, Butterwick D, Cook J: An exercise program in the treatment of fibromyalgia. J Rheumatol 1996, 23:1050–1053.

    PubMed  CAS  Google Scholar 

  7. Norregaard J, Lykkegaard JJ, Mehlsen J, Danneskiold-Samoe B: Exercise training in treatment of fibromyalgia. J Musculoskeletal Pain 1997, 5(1):71–79.

    Article  Google Scholar 

  8. Gowans SE, deHueck A, Voss S, Richardson M: A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res 1999, 12(2):120–128. The first study to demonstrate the beneficial effects of water aerobics in treating fibromyalgia. Found that many of the gains at 3 months were lost at 6 months.

    Article  PubMed  CAS  Google Scholar 

  9. King S, Wessel J, Sholter D, Maksymowych W: A randomized controlled trial of exercise, education, and the combination of exercise and education in persons with fibromyalgia. Arthritis Rheumatism 1999, 42.

  10. Busch AJ, Schachter CL, Sheppard MS, Peloso PM: Home-based videotaped program of aerobics for fibromyalgia. SArthritis and Rheumatism 1999, 42. Large, randomized three-group study that was the first to attempt to examine the benefits of multiple short bouts of exercise. This design is theorized to be more tolerable to patients with fibromyalgia and is also in congruence with the most recent National Institutes of Health guidelines that recommend that most Americans could increase their fitness through three 10-minute bouts of exercise most days of the week.

  11. Rooks DS, Kantrowitz FG, Silverman C, Arnold HS: Effects of progressive strength training and cardiovascular exercise in women with fibromyalgia. Arthritis Rheumatism 1999, 42.

  12. White J, Hornsby J, Hornsby G, Ulrich I, Briggs R, Yeater R: A pilot study to determine the efficacy of aquatic therapy on functional outcome in fibromyalgia. Arthritis and Rheumatism 1999, 42.

  13. 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(5):501–505.

    Article  CAS  Google Scholar 

  14. Meiworm L, Jakob E, Walker UA, Peter HH, Keul J: Patients with fibromyalgia benefit from aerobic endurance exercise Clin Rheumatol 2000, (4):253–257.

    Article  Google Scholar 

  15. Burckhardt CS, Clark SR, Bennett RM: The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991, 18:728–733.

    PubMed  CAS  Google Scholar 

  16. Koltyn KF, Garvin AW, Gardiner RL, Nelson TF: Perception of pain following aerobic exercise. Med Sci Sports Exerc 1996, 28(11):1418–1421.

    PubMed  CAS  Google Scholar 

  17. Guieu R, Blin O, Pouget J, Serratrice G: Nociceptive threshold and physical activity. Can J Neurol Sci 1992, 19(1):69–71.

    PubMed  CAS  Google Scholar 

  18. Paulev PE, Thorboll JE, Nielsen U, et al.: Opioid involvement in the perception of pain due to endurance exercise in trained man. Jpn J Physiol 1989, 39(1):67–74.

    PubMed  CAS  Google Scholar 

  19. Goldfarb AH, Jamurtas AZ: Beta-endorphin response to exercise. An update. Sports Med 1997, 24(1):8–16.

    PubMed  CAS  Google Scholar 

  20. Koltyn KF: Analgesia following exercise: a review. Sports Med 2000, 29(2):85–98. Reviews human and animal studies regarding opioid and nonopioid systems examining whether analgesia follows exercise.

    Article  PubMed  CAS  Google Scholar 

  21. Grossman A, Sutton JR: Endorphins: what are they? How are they measured? What is their role in exercise? Med Sci Sports Exerc 1985, 17(1):74–81.

    PubMed  CAS  Google Scholar 

  22. Schwarz L, Kindermann W: Changes in beta-endorphin levels in response to aerobic and anaerobic exercise. Sports Med 1992, 13(1):25–36.

    PubMed  CAS  Google Scholar 

  23. Yunus MB, Denko CW, Masi AT: Serum beta-endorphin in primary fibromyalgia syndrome: a controlled study. J Rheumatol 1986, 13:183–186.

    PubMed  CAS  Google Scholar 

  24. King AC, Oman RF, Brassington GS, Bliwise DL, Haskell WL: Moderate-intensity exercise and self-rated quality of sleep in older adults: a randomized controlled trial. JAMA 1997, 277(1):32–37.

    Article  PubMed  CAS  Google Scholar 

  25. Singh NA, Clements KM, Fiatarone MA: A randomized controlled trial of the effect of exercise on sleep. Sleep 1997, 20(2):95–101.

    PubMed  CAS  Google Scholar 

  26. Mizuno K, Asano K, Okamoto K: Effect of night exercise on the following partially deprived sleep. Psychiatry Clin Neurosci 1998, 52(2):137–138.

    Article  PubMed  CAS  Google Scholar 

  27. Youngstedt SD, O’Connor PJ, Dishman RK: The effects of acute exercise on sleep: a quantitative synthesis. Sleep 1997, 20(3):203–214.

    PubMed  CAS  Google Scholar 

  28. Williams P, Lord SR: Effects of group exercise on cognitive functioning and mood in older women. Aust N Z J Public Health 1997, 21(1):45–52.

    PubMed  CAS  Google Scholar 

  29. Rikli RE, Edwards DJ: Effects of a three-year exercise program on motor function and cognitive processing speed in older women. Res Q Exerc Sport 1991, 62(1):61–67.

    PubMed  CAS  Google Scholar 

  30. Steinberg H, Sykes EA, Moss T, Lowery S, LeBoutillier N, Dewey A: Exercise enhances creativity independently of mood. Br J Sports Med 1997, 31(3):240–245.

    PubMed  CAS  Google Scholar 

  31. Partonen T, Leppamaki S, Hurme J, Lonnqvist J: Randomized trial of physical exercise alone or combined with bright light on mood and health-related quality of life. Psychol Med 1998, 28(6):1359–1364.

    Article  PubMed  CAS  Google Scholar 

  32. Katula JA, Blissmer BJ, McAuley E: Exercise intensity and self-efficacy effects on anxiety reduction in healthy, older adults. J Behav Med 1999, 22(3):233–247.

    Article  PubMed  CAS  Google Scholar 

  33. Babyak M, Blumenthal JA, Herman S, et al.: Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 2000, 62(5):633–638.

    PubMed  CAS  Google Scholar 

  34. Hayward LM, Sullivan AC, Libonati JR: Group exercise reduces depression in obese women without weight loss. Percept Mot Skills 2000, 90(1):204–208.

    PubMed  CAS  Google Scholar 

  35. Bandura A, O’Leary A, Taylor CB, Gauthier J, Gossard D: Perceived self-efficacy and pain control: opioid and nonopioid mechanisms. J Pers Soc Psychol 1987, 53:563–571.

    Article  PubMed  CAS  Google Scholar 

  36. Marcus BH, Selby VC, Niaura RS, Rossi JS: Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport 1992, 63(1):60–66.

    PubMed  CAS  Google Scholar 

  37. Buckelew SP, Huyser B, Hewett JE, et al.: Self-efficacy predicting outcome among fibromyalgia subjects. Arthritis Care Res 1996, 9:97–104.

    Article  PubMed  CAS  Google Scholar 

  38. Vlaeyen JW, Linton SJ: Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000, 85(3):317–332. Review article of the fear avoidance model of exaggerated pain perceptions. Reviews existing assessment tools and implications for treatment.

    Article  PubMed  CAS  Google Scholar 

  39. Asmundson GJ, Kuperos JL, Norton GR: Do patients with chronic pain selectively attend to pain-related information? Preliminary evidence for the mediating role of fear. Pain 1997, 72:27–32.

    Article  PubMed  CAS  Google Scholar 

  40. Brown DR, Wang Y, Ward A, et al.: Chronic psychological effects of exercise and exercise plus cognitive strategies. Med Sci Sports Exerc 1995, 27(5):765–775.

    PubMed  CAS  Google Scholar 

  41. Marcus BH, Selby VC, Niaura RS, Rossi JS: Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport 1992, 63(1):60–66.

    PubMed  CAS  Google Scholar 

  42. Jensen MP, Turner JA, Romano JM: Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment. Pain 1991, 44(3):263–269.

    Article  PubMed  CAS  Google Scholar 

  43. Balnave CD, Thompson MW: Effect of training on eccentric exercise-induced muscle damage. J Appl Physiol 1993, 75(4):1545–1551.

    PubMed  CAS  Google Scholar 

  44. Spina RJ, Chi MM, Hopkins MG, Nemeth PM, Lowry OH, Holloszy JO: Mitochondrial enzymes increase in muscle in response to 7–10 days of cycle exercise. J Appl Physiol 1996, 80(6):2250–2254.

    PubMed  CAS  Google Scholar 

  45. Kuipers H: Exercise-induced muscle damage. Int J Sports Med 1994, 15(3):132–135.

    PubMed  CAS  Google Scholar 

  46. Clarkson PM, Newham DJ: Associations between muscle soreness, damage, and fatigue. Adv Exp Med Biol 1995, 384:457–469.

    PubMed  CAS  Google Scholar 

  47. Kanaley JA, Weltman JY, Veldhuis JD, Rogol AD, Hartman ML, Weltman A: Human growth hormone response to repeated bouts of aerobic exercise. J Appl Physiol 1997, 83(5):1756–1761.

    PubMed  CAS  Google Scholar 

  48. Pritzlaff CJ, Wideman L, Weltman JY, et al.: Impact of acute exercise intensity on pulsatile growth hormone release in men. J Appl Physiol 1999, 87(2):498–504.

    PubMed  CAS  Google Scholar 

  49. Bennett RM, Cook DM, Clark SR, Burckhardt CS, Campbell SM: Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia. J Rheumatol 1997, 24(7):1384–1389.

    PubMed  CAS  Google Scholar 

  50. Paiva ES, Deodhar A, Jones K, Bennett RM: Growth hormone unresponsiveness to exercise in fibromyalgia patients is normalized by administration of pyridostigmine. Arthritis Rheum 1999, 42:S395.

    Article  Google Scholar 

  51. Weigent DA, Bradley LA, Blalock JE, Alarcon GS: Current concepts in the pathophysiology of abnormal pain perception in fibromyalgia. Am J Med Sci 1998, 315(6):405–412. Reviews recent data supporting the links among each of the three systems—the musculoskeletal system, the neuroendocrine system, and the central nervous system (CNS), all of which appear to play major roles in fibromyalgia pathophysiology—and pain in fibromyalgia. Presents a model of the pathophysiology of abnormal pain perception in fibromyalgia that integrates the research findings described.

    Article  PubMed  CAS  Google Scholar 

  52. Bennett RM: Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia. Mayo Clin Proc 1999, 74(4):385–398. Reviews this new body of knowledge, with particular reference to the chronic pain state termed "fibromyalgia."

    PubMed  CAS  Google Scholar 

  53. Graven-Nielsen T, Aspegren KS, et al.: Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Pain 2000, 85(3):483–491. Research study that shows that mechanisms involved in referred pain, temporal summation, muscular hyperalgesia, and muscle pain at rest were attenuated by the NMDA-antagonist in patients with fibromyalgia syndrome (FMS). It suggests a link between central hyperexcitability and the mechanisms for facilitated referred pain and temporal summation in a subgroup of the patients with FMS.

    Article  PubMed  CAS  Google Scholar 

  54. Henriksson KG: Is fibromyalgia a distinct clinical entity? Pain mechanisms in fibromyalgia syndrome: a myologist’s view. Baillieres Best Pract Res Clin Rheumatol 1999, 13(3):455–461.

    Article  PubMed  CAS  Google Scholar 

  55. Svensson P, Minoshima S, Beydoun A, Morrow TJ, Casey KL: Cerebral processing of acute skin and muscle pain in humans. J Neurophysiol 1997, 78(1):450–460.

    PubMed  CAS  Google Scholar 

  56. Bennett RM: The contribution of muscle to the generation of fibromyalgia symptomatology. J Musculoskeletal Pain 1996, 4:35–59.

    Article  Google Scholar 

  57. Olsen NJ, Park JH: Skeletal muscle abnormalities in patients with fibromyalgia. Am J Med Sci 1998, 315(6):351–358.

    Article  PubMed  CAS  Google Scholar 

  58. Watkins LR, Maier SF, Goehler LE: Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain 1995, 63:289–302.

    Article  PubMed  CAS  Google Scholar 

  59. Smith LL: Cytokine hypothesis of overtraining: a physiological adaptation to excessive stress? Med Sci Sports Exerc 2000, 32(2):317–331.

    Article  PubMed  CAS  Google Scholar 

  60. Fielding RA, Evans WJ: Aging and the acute phase response to exercise: implications for the role of systemic factors on skeletal muscle protein turnover. Int J Sports Med 1997, 18(Suppl 1):S22-S27.

    Article  PubMed  CAS  Google Scholar 

  61. Pedersen BK, Ostrowski K, Rohde T, Bruunsgaard H: The cytokine response to strenuous exercise. Can J Physiol Pharmacol 1998, 76(5):505–511.

    Article  PubMed  CAS  Google Scholar 

  62. Budgett R: Fatigue and underperformance in athletes: the overtraining syndrome. Br J Sports Med 1998, 32(2):107–110.

    PubMed  CAS  Google Scholar 

  63. Urhausen A, Gabriel HH, Kindermann W: Impaired pituitary hormonal response to exhaustive exercise in overtrained endurance athletes. Med Sci Sports Exerc 1998, 30(3):407–414.

    PubMed  CAS  Google Scholar 

  64. Uusitalo AL, Huttunen P, Hanin Y, Uusitalo AJ, Rusko HK: Hormonal responses to endurance training and overtraining in female athletes. Clin J Sport Med 1998, 8(3):178–186.

    Article  PubMed  CAS  Google Scholar 

  65. Lehmann M, Foster C, Dickhuth HH, Gastmann U: Autonomic imbalance hypothesis and overtraining syndrome. Med Sci Sports Exerc 1998, 30(7):1140–1145.

    Article  PubMed  CAS  Google Scholar 

  66. Armstrong RB, Warren GL, Warren JA: Mechanisms of exerciseinduced muscle fiber injury. Sports Med 1991, 12:184–207.

    PubMed  CAS  Google Scholar 

  67. Suzuki K, Totsuka M, Nakaji S, et al.: Endurance exercise causes interaction among stress hormones, cytokines, neutrophil dynamics, and muscle damage. J Appl Physiol 1999, 87(4):1360–1367.

    PubMed  CAS  Google Scholar 

  68. Bruunsgaard H, Galbo H, Halkjaer-Kristensen J, Johansen TL, MacLean DA, Pedersen BK: Exercise-induced increase in serum interleukin-6 in humans is related to muscle damage. J Physiol (Lond) 1997, 499:833–841.

    CAS  Google Scholar 

  69. Fry RW, Grove JR, Morton AR, Zeroni PM, Gaudieri S, Keast D: Psychological and immunological correlates of acute overtraining. Br J Sports Med 1994, 28(4):241–246.

    PubMed  CAS  Google Scholar 

  70. Puffer JC, McShane JM: Depression and chronic fatigue in athletes. Clin Sports Med 1992, 11(2):327–338.

    PubMed  CAS  Google Scholar 

  71. Suzuki K, Yamada M, Kurakake S, et al.: Circulating cytokines and hormones with immunosuppressive but neutrophil-priming potentials rise after endurance exercise in humans. Eur J Appl Physiol 2000, 81(4):281–287.

    Article  PubMed  CAS  Google Scholar 

  72. Shephard RJ, Shek PN: Potential impact of physical activity and sport on the immune system—a brief review. Br J Sports Med 1994, 28(4):247–255.

    Article  PubMed  CAS  Google Scholar 

  73. Selye H: A syndrome produced by diverse nocuous agents. 1936. J Neuropsychiatry Clin Neurosci 1998, 10(2):230–231.

    PubMed  CAS  Google Scholar 

  74. Niess AM, Dickhuth HH, Northoff H, Fehrenbach E: Free radicals and oxidative stress in exercise—immunological aspects. Exerc Immunol Rev 1999, 5:22–56.

    PubMed  CAS  Google Scholar 

  75. Park JH, Phothimat P, Oates CT, Hernanz-Schulman M, Olsen NJ: Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia. Arthritis Rheum 1998, 41(3):406–413.

    Article  PubMed  CAS  Google Scholar 

  76. Jubrias SA, Bennett RM, Klug GA: Increased incidence of a resonance in the phosphodiester region of 31P nuclear magnetic resonance spectra in the skeletal muscle of fibromyalgia patients. Arthritis Rheum 1994, 37:801–807.

    Article  PubMed  CAS  Google Scholar 

  77. Mengshoel AM, Vollestad NK, Forre O: Pain and fatigue induced by exercise in fibromyalgia patients and sedentary healthy subjects. Clin Exp Rheumatol 1995; 13(4):477–482.

    PubMed  CAS  Google Scholar 

  78. O’Connor PJ, Youngstedt SD: Influence of exercise on human sleep. Exerc Sport Sci Rev 1995, 23:105–134.

    PubMed  CAS  Google Scholar 

  79. Buguet A, Cespuglio R, Radomski MW: Sleep and stress in man: an approach through exercise and exposure to extreme environments. Can J Physiol Pharmacol 1998, 76(5):553–561.

    Article  PubMed  CAS  Google Scholar 

  80. Bennett RM, Jacobsen S: Muscle function and origin of pain in fibromyalgia. Bailliere’s Clin Rheumatol 1994, 8(4):721–746.

    Article  CAS  Google Scholar 

  81. American College of Sports Medicine, Position Stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness and flexibility in healthy adults. Med Sci Sports Exerc 1998, 30(6):975–991. Presents underlying principles for health-related benefits of exercise.

    Article  Google Scholar 

  82. McHugh MP, Connolly DA, Eston RG, Kremenic IJ, Nicholas SJ, Gleim GW: The role of passive muscle stiffness in symptoms of exercise-induced muscle damage. Am J SPP Sports Med 1999, 27(5):594–599.

    CAS  Google Scholar 

  83. Selye H: Stress and distress. Compr Ther 1975, 1(8):9–13.

    PubMed  CAS  Google Scholar 

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  1. Oregon Health Sciences University, 3181 SW Sam Jackson, L323, 97201, Portland, OR, USA

    S. R. Clark, K. D. Jones, C. S. Burckhardt & Robert M. Bennett

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  1. S. R. Clark
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Clark, S.R., Jones, K.D., Burckhardt, C.S. et al. Exercise for patients with fibromyalgia: Risks versus benefits. Curr Rheumatol Rep 3, 135–146 (2001). https://doi.org/10.1007/s11926-001-0009-2

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