Fibromyalgia affects five million adults in the United States.1 Most people are diagnosed with fibromyalgia during middle age and the prevalence increases with age.2
People with fibromyalgia have approximately one hospitalization every three years.3 More than five million ambulatory care visits occur per year for problems related to fibromyalgia and the total cost for care is almost $6,000 per person, per year.4
The criteria for diagnosis of fibromyalgia include obligatory criteria and minor criteria: chronic aches in three or more areas and multiple tender points (obligatory), and disturbed sleep, generalized fatigue, subjective swelling and numbness, pain in neck and shoulders, chronic headaches and irritable bowel syndrome (minor).
In addition to these criteria and the assessment tool discussed in our previous article, another evaluative nugget is from a study titled "Handgrip Strength Test as a Complimentary Tool in the Assessment of Fibromyalgia Severity in Women."5
This study showed that handgrip strength is reduced in women with fibromyalgia and the discriminator for presence or absence is whether on a dynamometer test, the woman scores above or below 23.1 Kg. If she scores below this, it is indicative of fibromyalgia. Women with severe fibromyalgia score 16.9 Kg or below.5
In exploring treatment, the mainstay is exercise. Several sources ranging from The Ottawa Panel's Evidence-Based Clinical Practice Guidelines for the Management of Fibromyalgia and other studies strongly suggest exercise and give the following parameters to most effectively deliver exercise to people with fibromyalgia:6-8
Parameters for exercising with fibromyalgia include:
1. Aerobic fitness exercises are recommended;
2. Strength training exercises are recommended;
3. Prescribe stretching after exercise;
4. Exercise at 60 to 70 percent of maximum heart rate;
5. Use active range of motion as warm-up;
6. Tai Chi can be beneficial for fibromyalgia.9
A study by Buckelew titled "Biofeedback/Relaxation Training and Exercise Interventions for Fibromyalgia: A Prospective Trial" looked at 120 patients assigned to one of four groups. The groups were 1) biofeedback/relaxation; 2) exercise training; 3) combination of groups one and two, and 4) education/attention group as the control.
What they found is that all three intervention groups improved in self-efficacy. They also found that the exercise alone and combination group improved in physical activity measures and kept the benefit the longest.10
Another study looked at the effects of a one-and-a-half-day outpatient multidisciplinary program on fibromyalgia.11 This study done by Pfeiffer used a treatment of education, self-management and a comprehensive physical and occupational therapy program at the discretion of the therapist. He found the treatment group improved significantly in function as compared to the control group.
Another multidisciplinary team study was conducted by Bailey and this program still exists today on a national level. It is the basis of the Fibro-Fit Program.12 The Fibro-Fit program is a 12-week, three times per week program with physical, occupational therapy and social work. The program includes orientation, self-management, goal setting, stretching, strengthening, aerobics, counseling and education in sleep, stress, fatigue, nutrition and coping.
The group that received this 12-week program did significantly better in pain and functional scores when compared to the control group.
The final study is the first to effectively deliver a strength-training program to people with fibromyalgia.13 This article is titled "The Effects of 12-week Strength Training Program in Women with Fibromyalgia." Prior to this study, strength training was not encouraged.
The program used was a twice-a-week, full-body, strength-training program. They worked all muscle groups at 40 percent of 1 RM (repetition maximum). Before and after the strength-training session, the participants did a five-minute warm-up and cool down. The experimental group improved in strength, pain and function when compared to the control group.
With the facts that fibromyalgia is prevalent, costly and can be functionally devastating, it is important that we look to the evidence for means to help people with fibromyalgia work toward finding fitness.
References available at www.advanceweb.com/PT.
Carole Lewis is co-owner of the Center of Evidence and consultant to Professional Sportscare and Rehab. She lectures exclusively for Great Seminars and Books and Great Seminars Online (www.greatseminarsandbooks.com and www.greatseminarsonline.com). She is also editor-in-chief of Topics in Geriatric Rehabilitation (www.topicsingeriatricrehabilitation.com) and an adjunct professor at George Washington University Department of Geriatrics, College of Medicine. Keiba L. Shaw is associate professor at Nova Southeastern University, College of Health Care Sciences, Physical Therapy Department, Hybrid Entry-Level DPT Program, Tampa, FL.