Getting Women with Fibromyalgia Moving

What is fibromyalgia and what exactly what does exercise have to do with the treatment and long-term outcome of the condition?  A recent study published in Medicine & Science in Sports & Exercise is helpful in understanding the relationship between fibromyalgia and exercise and how clinicians (and patients) might find better strategies for treatment.

Fibromyalgia is a clinically defined pain syndrome estimated to affect about 5 per cent of the general population with criteria for diagnosis defined by the American College of Rheumatology to include:

• Pain in all four quadrants of the body
• Pain along the spine
• Presence of 11 of 18 specific tender points

The 18 specific tender points (or trigger points) are outlined in the accompanying public domain figure from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and Wikipedia.

Women have higher prevalence rates for fibromyalgia.  The reason for this gender discrepancy in unknown as is the cause of the disorder.   Patients meeting criteria for this medical pain disorder commonly have significant cognitive and emotional symptoms as well.   Endorsement rates for problems with cognitive impairment (poor concentration, memory problems, psychomotor speed problems and diminished attention span) are common in fibromyalgia.  Additionally, rates of anxiety and mood symptoms and disorders appear high.  The cause for this association is also unknown.

Like many pain syndromes, exercise seems to be helpful in the long-term management of fibromyalgia.  Although a natural response to pain is to reduce activity, this physical withdrawal can be counterproductive to a good long-term outcome.  It is important for women with fibromyalgia and their physicians to assess and monitor response to exercise as a key component to treatment.

McLoughlin and a research team from the University of Iowa and the University of Wisconsin studied the relationship between self-reported exercise and actual exercise in a group of women with fibromyalgia and a group of women without fibromyalgia.  They utilized an accelerometer that was worn on the hip for 7 days to compare actual activity levels to what the women were reporting.   The key findings from the study were:

• Fibromyalgia subjects reported less physical activity (confirmed by accelerometer data) than controls
• Both those with fibromyalgia and controls reported higher levels of activity than could be validated by accelerometer data
• Self-report activity levels were poorly correlated with accelerometer activity in fibromyalgia but not controls
• High depression scores in fibromyalgia correlated with lower physical activity

For clinicians, the take home message here is you can’t rely only on your fibromyalgia patient’s self-report of exercise.  I think we will be seeing more use of devices such as accelerometers in clinical practice to get a more objective measure of physical activity.  Similar movement measurement capabilities (like those found in accelerometers) are available in the iPhone and iPod Touch.  Such tools may also be used to monitor change in activity with a new intervention, i.e. attending Jazzercise on a regular basis.  Targeting depression treatment in women with fibromyalgia may be one method to improve the chances of getting activity levels up.

The need for implementing activity programs is not limited to the medical illness of fibromyalgia.  Similar programs in obesity, heart disease, diabetes and lung disease are needed.  Collecting activity levels in these and other medical conditions may give clinicians additional insight into the effects of inactivity on disease progression.

Getting activity levels up in fibromyalgia can lead to significant improvement.  A recent trial of exercise in fibromyalgia by Fontaine and colleagues found regular activity reduced pain and reduced functional impairment.  This intervention paired education with a pedometer data that would be monitored by the research team.  When accountability is incorporated in exercise trials, compliance and benefits go up.

MCLOUGHLIN, M., COLBERT, L., STEGNER, A., & COOK, D. (2011). Are Women with Fibromyalgia Less Physically Active than Healthy Women? Medicine & Science in Sports & Exercise, 43 (5), 905-912 DOI: 10.1249/MSS.0b013e3181fca1ea

Fontaine KR, Conn L, & Clauw DJ (2010). Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: results of a randomized trial. Arthritis research & therapy, 12 (2) PMID: 20353551