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Managing fibromyalgia with complementary and alternative medical exercise: a systematic review and meta-analysis of clinical trials

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Abstract

Fibromyalgia is a chronic medical condition of unclear etiopathology that diminished patients’ quality of life; chronic pain is the main symptom, yet patients with fibromyalgia struggle also with depression, anxiety, and insomnia. For many years, pharmaceutical management of pain was the mainstay of treatment. In the latest decade, conventional low-impact aerobic exercise and complementary and alternative medical (CAM) exercise have become important when structuring a personalized therapeutic plan, since side effects are practically inexistent. Heterogenous studies with different methodological approaches have failed to display a clear clinical effect. We conducted a systematic review with meta-analysis of clinical trials putting emphasis on standardized measurable outcomes (Fibromyalgia Impact Questionnaire, FIQ) in our effort to draw a safe conclusion on CAM exercise’s effect. After analyzing 14 studies, including 886 patients, meta analysis showed CAM exercise had a beneficial effect on patients’ FIQ score reports: standardized mean difference (SMD) 1.330 (95% CI 0.733–1.928). Among them, dance and Tai chi, had a more profound effect: SMD 1.969 (95% CI 0.575–3.364) and SMD 1.852 (95% CI 0.119–3.584), respectively. However, the risk of bias was overall medium to high and statistical heterogeneity was very high. Our meta-regression analysis failed to identify any variable that could account for high heterogeneity. Even though more experimental studies should be done on this subject, CAM exercise seems beneficial for patients with Fibromyalgia.

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Data availability statement

All authors declare that the data supporting the findings of this study are available within the article and its supplementary information files.

References

  1. Offenbaecher MA-O, Kohls NA-O, Ewert TA-O, Sigl CA-O, Hieblinger RA-O, Toussaint LA-O, Sirois FA-OX, Hirsch JA-O, Vallejo MA-O, Kramer SA-O, Rivera JA-O, Stucki GA-O, Schelling JA-O, Winkelmann AA-O (2021) Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective “real world” data analysis of fibromyalgia patients. Rheumatol Int 41:1995–2006. https://doi.org/10.1007/s00296-020-04702-5

    Article  PubMed  Google Scholar 

  2. Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M, Saraiva F, Nacci F, Thomas E, Caubère JP, Le Lay K, Taieb C, Matucci-Cerinic M (2010) Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum 39:448–453. https://doi.org/10.1016/j.semarthrit.2008.12.003

    Article  PubMed  Google Scholar 

  3. Neumann L, Buskila D (2003) Epidemiology of fibromyalgia. Curr Pain Headache Rep 7:362–368. https://doi.org/10.1007/s11916-003-0035-z

    Article  PubMed  Google Scholar 

  4. Galvez-Sánchez CM, Reyes Del Paso GA (2020) Diagnostic criteria for fibromyalgia: critical review and future perspectives. J Clin Med 9:1219. https://doi.org/10.3390/jcm9041219

    Article  PubMed Central  Google Scholar 

  5. Wolfe F, Michaud K, Li T, Katz RS (2010) Chronic conditions and health problems in rheumatic diseases: comparisons with rheumatoid arthritis, noninflammatory rheumatic disorders, systemic lupus erythematosus, and fibromyalgia. J Rheumatol 37:305–315. https://doi.org/10.3899/jrheum.090781

    Article  PubMed  Google Scholar 

  6. Ahmed S, Aggarwal A, Lawrence A (2019) Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting. Rheumatol Int. 39(8):1397-1403. https://doi.org/10.1007/s00296-019-04323-7

  7. Staud R (2011) Peripheral pain mechanisms in chronic widespread pain. Best Pract Res 25:155–164. https://doi.org/10.1016/j.berh.2010.01.010

    Article  Google Scholar 

  8. Staud R, Nagel S, Robinson ME, Price DD (2009) Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. Pain 145:96–104. https://doi.org/10.1016/j.pain.2009.05.020

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ross RL, Jones KD, Bennett RM, Ward RL, Druker BJ, Wood LJ (2010) Preliminary evidence of increased pain and elevated cytokines in fibromyalgia patients with defective growth hormone response to exercise. Open Immunol J 3:9–18. https://doi.org/10.2174/1874226201003010009

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

    Article  PubMed  Google Scholar 

  11. Clauw DJ (2014) Fibromyalgia: a clinical review. JAMA 311:1547–1555. https://doi.org/10.1001/jama.2014.3266

    Article  PubMed  CAS  Google Scholar 

  12. Coskun Benlidayi I (2019) Role of inflammation in the pathogenesis and treatment of fibromyalgia. Rheumatol Int 39:781–791. https://doi.org/10.1007/s00296-019-04251-6

    Article  PubMed  CAS  Google Scholar 

  13. Rehm S, Sachau J, Hellriegel J, Forstenpointner J, Børsting Jacobsen H, Harten P, Gierthmühlen J, Baron R. (2021) Pain matters for central sensitization: sensory and psychological parameters in patients with fibromyalgia syndrome. Pain Rep 6(1):e901. https://doi.org/10.1097/PR9.0000000000000901

  14. Vecchio E, Lombardi R, Paolini M, Libro G, Delussi M, Ricci K, Quitadamo SG, Gentile E, Girolamo F, Iannone F, Lauria G, de Tommaso M. (2020) Peripheral and central nervous system correlates in fibromyalgia. Eur J Pain 24(8):1537–1547. https://doi.org/10.1002/ejp.1607

  15. Peng X, Robinson RL, Mease P, Kroenke K, Williams DA, Chen Y, Faries D, Wohlreich M, McCarberg B, Hann D (2015) Long-term evaluation of opioid treatment in fibromyalgia. Clin J Pain 31:7–13. https://doi.org/10.1097/ajp.0000000000000079

    Article  PubMed  Google Scholar 

  16. Fitzcharles MA, Ste-Marie PA, Gamsa A, Ware MA, Shir Y (2011) Opioid use, misuse, and abuse in patients labeled as fibromyalgia. Am J Med 124:955–960. https://doi.org/10.1016/j.amjmed.2011.05.031

    Article  PubMed  Google Scholar 

  17. Sañudo B, de Hoyo M, Carrasco L, McVeigh JG, Corral J, Cabeza R, Rodríguez C, Oliva A (2010) The effect of 6-week exercise programme and whole body vibration on strength and quality of life in women with fibromyalgia: a randomised study. Clin Exp Rheumatol 28:S40-45

    PubMed  Google Scholar 

  18. Schachter CL, Busch AJ, Peloso PM, Sheppard MS (2003) Effects of short versus long bouts of aerobic exercise in sedentary women with fibromyalgia: a randomized controlled trial. Phys Ther 83:340–358

    Article  Google Scholar 

  19. Wigers SH, Stiles TC, Vogel PA (1996) Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. Scand J Rheumatol 25:77–86. https://doi.org/10.3109/03009749609069212

    Article  PubMed  CAS  Google Scholar 

  20. Assumpção A, Matsutani LA, Yuan SL, Santo AS, Sauer J, Mango P, Marques AP (2018) Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. Eur J Phys Rehabil Med 54:663–670. https://doi.org/10.23736/s1973-9087.17.04876-6

    Article  PubMed  Google Scholar 

  21. Kayo AH, Peccin MS, Sanches CM, Trevisani VF (2012) Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial. Rheumatol Int 32:2285–2292. https://doi.org/10.1007/s00296-011-1958-z

    Article  PubMed  Google Scholar 

  22. Hooten MW, Qu W, Townsend CO, Judd JW (2012) Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: a randomized equivalence trial. Pain 153:915–923. https://doi.org/10.1016/j.pain.2012.01.020

    Article  PubMed  Google Scholar 

  23. Coskun Benlidayi I (2020)The effectiveness and safety of electrotherapy in the management of fibromyalgia. Rheumatol Int 40(10):1571–1580. https://doi.org/10.1007/s00296-020-04618-0

  24. Catala P, Lopez-Roig S, Ecija C, Suso-Ribera C, Peñacoba Puente C (2021) Why do some people with severe chronic pain adhere to walking prescriptions whilst others won't? A cross-sectional study exploring clinical and psychosocial predictors in women with fibromyalgia. Rheumatol Int 41(8):1479–1484. https://doi.org/10.1007/s00296-020-04719-w

  25. O'Dwyer T, Maguire S, Mockler D, Durcan L, Wilson F (2019) Behaviour change interventions targeting physical activity in adults with fibromyalgia: a systematic review. Rheumatol Int 39(5):805–817. https://doi.org/10.1007/s00296-019-04270-3

  26. da Silva JM, de Barros BS, Almeida GJ, O'Neil J, Imoto AM (2022) Dosage of resistance exercises in fibromyalgia: evidence synthesis for a systematic literature review up-date and meta-analysis. Rheumatol Int 42(3):413–429. https://doi.org/10.1007/s00296-021-05025-9

  27. Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJR (2020) AHRQ comparative effectiveness reviews, in noninvasive nonpharmacological treatment for chronic pain: a systematic review update. Agency for Healthcare Research and Quality, Rockville

    Book  Google Scholar 

  28. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL (2015) Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Report 1–16

  29. Health NCFCAI (2021) Complementary, alternative, or integrative health: what’s in a name? https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.

  30. Health NCFCAI (2016) Fibromyalgia: In Depth. https://www.nccih.nih.gov/health/fibromyalgia-in-depth.

  31. Mist SD, Firestone KA, Jones KD (2013) Complementary and alternative exercise for fibromyalgia: a meta-analysis. J Pain Res 6:247–260. https://doi.org/10.2147/jpr.S32297

    Article  PubMed  PubMed Central  Google Scholar 

  32. Burckhardt CS, Clark SR, Bennett RM (1991) The fibromyalgia impact questionnaire: development and validation. J Rheumatol 18:728–733

    PubMed  CAS  Google Scholar 

  33. Mease P, Arnold LM, Choy EH, Clauw DJ, Crofford LJ, Glass JM, Martin SA, Morea J, Simon L, Strand CV, Williams DA, Greoup OFW, Group O F W (2009) Fibromyalgia syndrome module at OMERACT 9: domain construct. J Rheumatol 36:2318–2329. https://doi.org/10.3899/jrheum.090367

    Article  PubMed  PubMed Central  Google Scholar 

  34. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Br Med J 349:7647. https://doi.org/10.1136/bmj.g7647

    Article  Google Scholar 

  35. Balk EM, Earley A, Patel K, Trikalinos TA, Dahabreh IJ (2012) Empirical assessment of within-arm correlation imputation in trials of continuous outcomes. Agency for Healthcare Research and Quality, Rockville

    Google Scholar 

  36. Altan L, Korkmaz N, Bingol U, Gunay B (2009) Effect of pilates training on people with fibromyalgia syndrome: a pilot study. Arch Phys Med Rehabil 90:1983–1988. https://doi.org/10.1016/j.apmr.2009.06.021

    Article  PubMed  Google Scholar 

  37. Baptista AS, Villela AL, Jones A, Natour J (2012) Effectiveness of dance in patients with fibromyalgia: a randomized, single-blind, controlled study. Clin Exp Rheumatol 30:18–23

    PubMed  Google Scholar 

  38. Carbonell-Baeza A, Aparicio VA, Martins-Pereira CM, Gatto-Cardia CM, Ortega FB, Huertas FJ, Tercedor P, Ruiz JR, Delgado-Fernandez M (2010) Efficacy of Biodanza for treating women with fibromyalgia. J Altern Complement Med 16:1191–1200. https://doi.org/10.1089/acm.2010.0039

    Article  PubMed  Google Scholar 

  39. Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD (2010) A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain 151:530–539. https://doi.org/10.1016/j.pain.2010.08.020

    Article  PubMed  PubMed Central  Google Scholar 

  40. Carson JW, Carson KM, Jones KD, Mist SD, Bennett RM (2012) Follow-up of yoga of awareness for fibromyalgia: results at 3 months and replication in the wait-list group. Clin J Pain 28:804–813. https://doi.org/10.1097/AJP.0b013e31824549b5

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ekici G, Unal E, Akbayrak T, Vardar-Yagli N, Yakut Y, Karabulut E (2017) Effects of active/passive interventions on pain, anxiety, and quality of life in women with fibromyalgia: randomized controlled pilot trial. Women Health 57:88–107. https://doi.org/10.1080/03630242.2016.1153017

    Article  PubMed  Google Scholar 

  42. Hammond A, Freeman K (2006) Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial. Clin Rehabil 20:835–846. https://doi.org/10.1177/0269215506072173

    Article  PubMed  Google Scholar 

  43. Jones KD, Sherman CA, Mist SD, Carson JW, Bennett RM, Li F (2012) A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clin Rheumatol 31:1205–1214. https://doi.org/10.1007/s10067-012-1996-2

    Article  PubMed  PubMed Central  Google Scholar 

  44. López-Rodríguez MM, Castro-Sánchez AM, Fernández-Martínez M, Matarán-Peñarrocha GA, Rodríguez-Ferrer ME (2012) Comparison between aquatic-biodanza and stretching for improving quality of life and pain in patients with fibromyalgia. Aten Primaria 44:641–649. https://doi.org/10.1016/j.aprim.2012.03.002

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lynch M, Sawynok J, Hiew C, Marcon D (2012) A randomized controlled trial of qigong for fibromyalgia. Arthritis Res Ther 14:R178. https://doi.org/10.1186/ar3931

    Article  PubMed  PubMed Central  Google Scholar 

  46. Maddali Bongi S, Paoletti G, Calà M, Del Rosso A, El Aoufy K, Mikhaylova S (2016) Efficacy of rehabilitation with Tai Ji Quan in an Italian cohort of patients with Fibromyalgia Syndrome. Complement Ther Clin Pract 24:109–115. https://doi.org/10.1016/j.ctcp.2016.05.010

    Article  PubMed  Google Scholar 

  47. Mannerkorpi K, Arndorw M (2004) Efficacy and feasibility of a combination of body awareness therapy and qigong in patients with fibromyalgia: a pilot study. J Rehabil Med 36:279–281. https://doi.org/10.1080/16501970410031912

    Article  PubMed  Google Scholar 

  48. Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, Lee Y, McAlindon T (2010) A randomized trial of tai chi for fibromyalgia. N Engl J Med 363:743–754. https://doi.org/10.1056/NEJMoa0912611

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. López-Rodríguez MM, Fernández-Martínez M, Matarán-Peñarrocha GA, Rodríguez-Ferrer ME, Granados Gámez G, Aguilar Ferrándiz E (2013) Effectiveness of aquatic biodance on sleep quality, anxiety and other symptoms in patients with fibromyalgia. Med Clin (Barc) 141:471–478. https://doi.org/10.1016/j.medcli.2012.09.036

    Article  Google Scholar 

  50. Bidonde J, Busch AJ, Schachter CL, Overend TJ, Kim SY, Góes SM, Boden C, Foulds HJ (2017) Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev 6:CD012700. https://doi.org/10.1002/14651858.CD012700

    Article  PubMed  Google Scholar 

  51. Staud R, Robinson ME, Weyl EE, Price DD (2010) Pain variability in fibromyalgia is related to activity and rest: role of peripheral tissue impulse input. J Pain 11:1376–1383. https://doi.org/10.1016/j.jpain.2010.03.011

    Article  PubMed  PubMed Central  Google Scholar 

  52. Angelopoulos TJ, Denys BG, Weikart C, Dasilva SG, Michael TJ, Robertson RJ (1995) Endogenous opioids may modulate catecholamine secretion during high intensity exercise. Eur J Appl Physiol Occup Physiol 70:195–199. https://doi.org/10.1007/bf00238563

    Article  PubMed  CAS  Google Scholar 

  53. Schwarz L, Kindermann W (1992) Changes in beta-endorphin levels in response to aerobic and anaerobic exercise. Sports Med 13:25–36. https://doi.org/10.2165/00007256-199213010-00003

    Article  PubMed  CAS  Google Scholar 

  54. Kemppainen P, Pertovaara A, Huopaniemi T, Johansson G, Karonen SL (1985) Modification of dental pain and cutaneous thermal sensitivity by physical exercise in man. Brain Res 360:33–40. https://doi.org/10.1016/0006-8993(85)91217-x

    Article  PubMed  CAS  Google Scholar 

  55. Janal MN, Colt EWD, Clark CW, Glusman M (1984) Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: effects of naloxone. Pain 19:13–25. https://doi.org/10.1016/0304-3959(84)90061-7

    Article  PubMed  CAS  Google Scholar 

  56. Clark SR, Burckhardt CS, Campbell S, O’Reilly C, Bennett RM (1993) Fitness characteristics and perceived exertion in women with fibromyalgia. J Musculoskelet Pain 1:191–197. https://doi.org/10.1300/J094v01n03_19

    Article  Google Scholar 

  57. Kool MB, van Middendorp H, Boeije HR, Geenen R (2009) Understanding the lack of understanding: invalidation from the perspective of the patient with fibromyalgia. Arthritis Rheum 61:1650–1656. https://doi.org/10.1002/art.24922

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hellenic Police Medical Center, Thessaloniki, Greece

    Paraschou Vasileios, Gkekas Nifon & Siolos Pavlos

  2. 2nd Pulmonary Department, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Haidari, Tempwn 8, Xrysoupoli, Athens, Greece

    Paraschou Vasileios

  3. Medical Department of Educational Central of Army Aviation, Greek Military Corps, Imathia, Greece

    Partalidou Styliani

  4. Internal Medicine Department, Euromedica, Thessaloniki, Greece

    Partalidou Styliani

  5. Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, Larissa, Greece

    Gkekas Nifon

  6. 1st Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Siolos Pavlos

  7. School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Fotiadis Aris

  8. 350 Guided Missile Wing Airbase, Hellenic Air Force, Thessaloniki, Greece

    Fotiadis Aris

  9. 2nd Air Surveillance Center Medical Department, Hellenic Air Force, Parnitha, Attiki, Greece

    Pantekidis Ioannis

  10. 3rd Orthopaedic Department, HYGEIA Hospital, Marousi, Athens, Greece

    Pantekidis Ioannis

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Contributions

PV and PI conceptualized, proposed and designed the study. PV, PS and SP searched the literature, screened and selected the eligible studies. PV, PS and SP assessed the quality of the studies included. PV and GN analyzed the data and carried out the statistical analyses. FA reviewed the data and revised statistical analyses to their final form. PV and PI contributed in drafting the manuscript, and all other authors reviewed it critically. All authors revised the final manuscript and approved its final version for publication submission. All authors agree to be accountable for the integrity and accuracy of all aspects of this work.

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Correspondence to Paraschou Vasileios.

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Vasileios, P., Styliani, P., Nifon, G. et al. Managing fibromyalgia with complementary and alternative medical exercise: a systematic review and meta-analysis of clinical trials. Rheumatol Int 42, 1909–1923 (2022). https://doi.org/10.1007/s00296-022-05151-y

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