Background: Fibromyalgia Syndrome (FMS) is a clinical condition with many symptoms such as chronic generalized pain, fatigue, sleep disorder, cognitive dysfunction and depressive mood. Management of FMS is difficult and the most important component is regular exercise.¹ In this syndrome, patients generally have compliance and motivation problems in maintenance of exercises. In recent years, exercises, with fun and game components, have been prescribed to increase patient compliance.² Motion-controlled video games targeting virtual reality are examples of these exercises.³

Objectives: To investigate the effect of motion controlled video games on pain, functionality, cardiopulmonary capacity and quality of life in fibromyalgic women.

Methods: Forty women (> 18 years) who have FMS were included in study. Patients were randomized into study and control groups. Control group performed aerobic exercise (cycling, 3 days/week, 20 minutes/day) for 4 weeks. Study group performed virtual reality exercise (Volleyball, Microsoft Xbox Kinect®, 3 days/week, 15 minutes/day) together with cycling exercise. After the four week supervised exercise program, both groups received the same home exercise program for four weeks. All patients were evaluated at baseline, 4th and 8th weeks. Primary outcome measure was Fibromyalgia Impact Questionnaire. Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale, Fatigue Severity Scale (FSS), Symptom Severity Scale, EuroQol-Quality of Life/Visual Analogue Scale (EQ5D-QoL/VAS) and 6 Minute Walk Test (6MWT) were used as secondary outcome measures. Positive and Negative Affect Schedule (PANAS) was used for patient satisfaction. T-test was used to compare demographic data between two groups. Repeated measures ANOVA was used in evaluation of intra-group efficiency of treatment. Treatment group and time interaction was evaluated by two-way analysis of variance. We calculated 20 patients per group, in order to find 14% minimal clinical difference in Fibromyalgia Impact Questionnaire with 80% power and 0.05 error rate (Tip 1 error).⁴

Results: All patients completed supervised exercise program (4 weeks). 34 patients (17 study group, 17 control group) were evaluated at the 8th week. Age, body mass index, education status, comorbidities and drug use were similar in both groups (p> 0.05). After four weeks, all outcome measures improved significantly in both groups (p<0.05). However, there was no statistically significant difference in all outcome measures between 4th and 8th weeks. Group and time interactions for 6MWT (F (1.21, 46.33) = 4.04, p = 0.043), FSS (F (1.61, 61.24) = 4.21, p = 0.026), EQ5D-QoL Scale (F (2, 76) = 4.55, p = 0.014) and EQ5D-VAS Scale (F (1.4, 53.55) = 3.59, p = 0.049) were significant only for the study group. In addition, PANAS score was significantly higher in study group (p <0.001).

Conclusion: Virtual reality exercises along with aerobic exercise increase cardiopulmonary capacity and quality of life in FMS. In addition, they increase patient satisfaction and may improve patient compliance to exercise.

References: [1] Bidonde J et al. Aerobic exercise training for adults with fibromyalgia. The Cochrane Library, 2017.

[2] Botella C et al. Virtual reality in the treatment of pain. JCR 2008;1:93.

[3] Garcia-Palacios A et al. Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia. The Clinical Journal of Pain, 2015, 31.6: 564-572.

[4] Bennett RM et al. Minimal clinically important difference in the fibromyalgia impact questionnaire. The Journal of Rheumatology, 2009, jrheum. 081090.

Disclosure of Interests: None declared