Physical activity interventions for individuals with fibromyalgia: a review and synthesis of best evidence
Background: Fibromyalgia (FM) disorder commonly involves musculoskeletal widespread pain and other symptoms like fatigue, sleep disruption, depression and anxiety and is associated with disability, work disability and high health care utilization. An integrated approach combining pharmacological and non-pharmacological treatments is advised to manage the disorder. Among the non-pharmacological interventions exercise has been shown to help; however, details about effectiveness of different types of interventions remain unknown. Objectives: The objective of this dissertation was to synthesize the evidence on the effectiveness of: a) Aquatic exercise interventions for adults with FM as reported in randomized control trials (RCTs), and b) any physical activity interventions for adults with FM as reported in systematic reviews. This was done by conducting a Cochrane systematic review of an aquatic training intervention and second, synthesizing the effectiveness of a variety of exercise interventions. Methods: For the Cochrane systematic review, nine electronic databases were searched. Selection criteria included full text publication of a RCT including an aquatic exercise intervention (AQ) (exercise in water was >50% of the full intervention) and provision of between-group outcome data. Pairs of reviewers independently screened and selected articles, assessed risk of bias, and extracted data on 24 outcomes. Effects of the interventions were evaluated using mean, standardized mean differences and 95% confidence interval (MD/SMD [95% CI]). Specific computer software designed for meta-analysing and evaluating the quality of evidence were used (i.e RevMan, GradePro). The second review, the synthesis of a variety of exercise interventions or umbrella systematic review, inspected six electronic databases for the January 1st 2007 to March 31st 2012 period. We included systematic Cochrane and non-Cochrane reviews that reported on the effects of any physical activity intervention for adults with FM. Pairs of reviewers independently screened and selected articles, assessed quality of the reviews using a valid and reliable tool (AMSTAR tool), and extracted data on four outcomes. Effects of the interventions were evaluated using standardized mean differences and 95% confidence intervals (SMD [95% CI]). We planned to use RevMan software for meta-analysis but due to heterogeneity of the reviews this was not done. Results: The Cochrane review examined 16 aquatic exercise training studies (n = 881). Nine studies compared aquatic exercise to control, five studies compared aquatic exercise to land-based exercise, and two compared aquatic to a different aquatic program. The aquatic vs control studies provided low to moderate quality evidence suggesting that aquatic training is beneficial for wellness, symptoms and fitness in adults with FM. The aquatic vs land group results suggested very low to low quality evidence that there are no differences in benefits between aquatic and land-based exercise except in muscle strength (very low quality evidence favoring land). In examining aquatic vs aquatic meta-analyses was not possible and only one difference in a major outcome was found. The umbrella systematic review synthesis of information (n-= nine systematic reviews) found positive results for diverse exercise interventions on pain, multidimensional function, and self-reported physical function and no conclusive evidence for new (to FM) physical activity mode (i.e. qigong, tai chi). There are however, methodological weaknesses in some of the reviews which reduce applicability of the research to clinical practice. Adverse effects reported suggest there was no serious harm performing physical activity for individuals with FM. Conclusions: Exercise interventions have the potential to positively impact individuals with FM including several outcomes like quality of life, physical functioning and pain. While some interventions had statistically significant results, methodological limitations prevented us from arriving at conclusions regarding particular elements and modes of exercise that will help inform health professional’s clinical practice. On the other hand, some preliminary analysis showed that variables like age, disease duration, disease severity and pain intensity warrant further exploration. A rigorous scientific process (or quality research) as the precursor of quality evidence is crucial for validity and credibility of the information and our future understanding of the effectiveness of exercise interventions for individuals with FM.
DegreeDoctor of Philosophy (Ph.D.)
DepartmentCommunity Health and Epidemiology
SupervisorBusch, Angela J.; Reeder, Bruce
CommitteeJanzen, Bonnie (Chair); Schachter, Candice; Li, Linda; Premkumar, Kalyani; Harrison, Liz; Brosseau, Lucie (External)
Copyright DateJuly 2014