Non-Pharmacologic Management of Rheumatic Illnesses - New Findings About Exercise - Combining Approaches: The Sum is Greater
Abstract 1635 A Randomized Controlled Trial of Exercise, Education and the Combination of Exercise and Education in Persons with Fibromyalgia
S King, J. Wessel, D Sholter, W Maksymowych, W Maksymowych Edmonton and Hamilton, Canada
Objective: To determine whether a combined program of exercise and education offers additional benefits to women with Fibromyalgia.
Methods: A total of 111 women who met the ACR criteria for Fibromyalgia were randomized to a 12-week program of : 1) moderate intensity aerobic exercise (EX: n=39); 2) education (i.e., a self-management program)(ED: n=25); 3) exercise + education (EX + ED: n=25); or 4) control (n=25).
Results: Over 12 weeks, individuals who exercised (i.e., the EX group and the EX + ED group) demonstrated significant improvements in physical functioning, as indicated by the 6-minute walk distances (p= 0.001). Those in the combined group (EX + ED group) also reported improvements in self-efficacy to manage their pain (p= 0.003), coping (p= 0.001) and function (p = 0.03), as well as decreased impact of the illness (p= 0.004).
Editorial Comments: There were several novel aspects to this trial. First, to increase long-term adherence to exercise, the investigators offered their programs in community rather than clinical settings. Also, participants were encouraged to try a number of moderate-intensity aerobic activities (i.e., swimming, treadmill, etc.) at each session to provide variety. Limitations of the study included differential contact time among groups (i.e., 1.5 hours per week for ED versus up to 4.5 hours per week for EX + ED). Because exercise was offered in a group format, those in the EX group also had opportunities for group support, social interaction and educational--all important elements that have been shown to have independent effects on treatment outcomes.
Bottom line: Combining exercise with education is more effective than either program alone in reducing the symptoms of Fibromyalgia. The authors are currently evaluating long-term results of this trial, which may offer insights into whether offering flexible programs in convenient settings can enhance long-term exercise adherence.
Abstract 1619 An Exercise and Self-Management Program in the Management of Fibromyalgia
L Martin, R Brant, A Nutting, D Butterwick, B MacIntosh, J Jones, C Hooper, R Kennedee, D Lieske Calgary, Canada
Objective: To determine the long-term effects of a program of exercise and exercise + self-management on the symptoms of Fibromyalgia
Methods: A total of 111 persons with Fibromyalgia (ACR criteria) were randomly assigned to a six week program of: 1) exercise (EX) or 2) exercise + a self-management program (EX+SM). The aerobic program consisted of six weeks of supervised aerobic and strength training classes. Classes lasted one hour and were offered three times per week.
Results: Both groups showed significant improvements in physical fitness, flexibility, self-efficacy and decreased impact of the illness at the end of 6 weeks, 4 months and 8 months. No between groups differences were observed at any time point.
Editorial Comments: This study suggests that both short- and long-term benefits occur with an intensive exercise program. In contrast to the previous studies, the investigators found no additional benefit by combining exercise with a program of self-management. The authors may be premature in concluding that "the addition of a self-management program did not play [sic] add additional benefit to that obtained by exercise alone." Participants in this study received an intensive supervised program of vigorous exercise three times a week. Vigorous activity offers optimal physical and psychological outcomes. In addition, within the exercise classes, there was likely ample opportunity for social interaction, "group support," education and other positive elements associated with a self-management program. Thus, a ceiling effect may in part explain that finding that providing an additional hour of support and education, above and beyond that already included in the intensive exercise program does not appear to offer additional benefits. While these results are indeed encouraging, long-term exercise adherence was not monitored.
Bottom line: While vigorous physical activity offers optimal improvements in health and well being, it is associated with higher rates of injury and poorer long-term adherence than moderate intensity physical activity. Patients who are currently exercising vigorously should be encouraged to maintain this level of activity; those who are sedentary should be encouraged to begin slowly with short bouts of moderate intensity activity. Individuals who exercise erratically should focus on achieving consistency in their exercise program before increasing intensity.