FIBROMYALGIA IMPROVES WITH STRENGTH TRAINING

Fibromyalgia (FM) is a chronic disease characterized by generalized skeletal muscle pain (1, 2), and other common symptoms include fatigue, sleep disorders, depression, and excessive anxiety (3–6). The pathogenesis of FM is still not well understood (7), and FM is considered by some researchers to be a neurobiological disease caused by abnormal processing of pain (8).

There is currently no cure for FM, but palliative treatments are available. One type of treatment is strength training (ST). The aim of this study was to analyze the effects of ST in the treatment of FM through a systematic review of experimental research. Twenty-two studies were included in the review. Women aged 18–65 years comprised the total sample and the main variables analyzed were pain, strength, muscular activity, functional capacity, fatigue, quality of life, and sleep. 

Information extracted from: (Andrade, A., de Azevedo Klumb Steffens, R., Sieczkowska, S. M., Peyré Tartaruga, L. A., & Torres Vilarino, G. (2018). A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Advances in Rheumatology, 58(1). doi:10.1186/s42358-018-0033-9). 

 

Results

 The analysis of the results revealed that ST reduced the symptoms of patients with FM, such as pain, fatigue, number of tender points, depression, and anxiety, with improved functional capacity and quality of life (9, 10, 11, 12, 13, 14, 15, 16), despite the different training protocols used.

 Pain

Pain was the most studied variable, showing a reduction after ST (11, 12, 17, 18, 19–21). No study reported increased pain after or during the intervention period

 Muscle Strength

With regard to muscle strength, increases between 33 and 63% were observed after 21 and 16 weeks (15, 22).

 Quality of life and Functionality

Studies analysing quality of life and functionality showed that ST is effective in improving these variables (23, 12, 24, 15, 16, 18).

 Depression

The most investigated psychological variable was depression. The studies of Jones et al. (18), Gavi et al. (12), and Assumpção et al. (25) showed that ST reduces depressive symptoms; however, the study of Ericsson et al. (10) did not find a significant difference after 15 weeks of intervention.

 Sleep Quality

We also analyzed the results related to sleep quality. Andrade et al. (9) found that sleep disorders were reduced after ST and that sleep correlated with pain. The results of Ericsson et al. (10) also disclosed that ST yielded better results than relaxation sessions in improving sleep quality. In addition, another important result is that patients with FM presented similar responses to those of healthy persons; thus, they recommended ST to assist in the treatment of patients.

  

Training Protocol

It was observed that there is no specific training protocol for patients with FM; thus, the researchers developed their own protocol.
 Intervention protocols should start at low intensity (40% of 1RM) and gradually increase the intensity. ST should be performed 2 or 3 times a week to exercise the main muscle groups.  The current studies showed that ST is a safe and effective method of improving the major symptoms of FM and can be used to treat patients with this condition.  

Example of Training Protocol, Rooks et al. (18)

The intervention was designed to gradually increase the volume and intensity of exercise a person performed, to involve all major muscle groups of the body, and to include all 3 aspects of fitness— cardiovascular endurance, muscle strength, and joint flexibility.
 The exercises began with a low volume of exercise performed at a low intensity, because of the expected lower levels of cardiovascular fitness and muscle strength reported in women with Fibromyalgia, and the lower threshold for postexercise muscle pain and fatigue seen in this population. Participants exercised for 60 minutes per session, 3 times per week for 20 weeks. The intervention was composed of 2 phases of exercise.

 The first phase (4 weeks) was performed in a pool, and focused on active range of motion of the body’s major joints. Movements were controlled single-joint motions.

 The second phase (16 weeks) involved land-based exercises for improving cardiovascular endurance, muscle strength, and joint range of motion. Each exercise session was divided into 3 sections—cardiovascular, strength training, and flexibility—and was always performed in the same order.

 - Cardiovascular exercises incorporated walking on a treadmill (Life Fitness), an elliptical device (Precor, Bothell, WA), and walking on a track.

 - Strength training exercises included static contractions for pelvic and lumbar spine stabilization, and dynamic movement of large muscles and multijoint actions: hip flexion/extension, knee extension/flexion, ankle plantar/dorsiflexion, shoulder flexion, extension, abduction and horizontal adduction and abduction, elbow flexion and extension, and trunk flexion and rotation.
Strength training exercises were performed using a combination of machines (Life Fitness), hand weights, and body weight. Subjects began with resistance levels they could do easily, and progressed in an 8-10-12-12 repetition format when appropriate.

 - Flexibility was developed using a complete range of motion during strength training movements, traditional stretches, and a flexibility device (Precor).

 The land-based exercise program was revised after 3 months to prevent boredom and reduce the chance of dropout.  

Conclusion

In conclusion, ST had positive effects on physical and psychological symptoms, in terms of reducing pain, the number of tender points, and depression, and improving muscle strength, sleep quality, functional capacity, and quality of life.  

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