EXERCISES FOR

TREATING
FIBROMYALGIA
SYNDROME
Ms. Sweeta Priyadarshini
Physical Therapy Intern
Christian Medical College
 Cochrane Database of Systematic
Reviews 2007

 Busch AJ, Barber KA, Overend TJ, Peloso

PMJ, Schachter CL
 Chronic widespread pain illness
 Muscular Rheumatism/Fibrositis
 2% of the general population
 F:M :: 9:1 (ACR)
 20-50 yrs
 ETIOLOGY
 Genetic Predisposition
 Stress-induced
 Sleep disturbance
 Hormonal: reduction in
dopamine/serotonin/HGH
 Co-morbidity
 CLASSIFICATION
 Primary
 Secondary: Physical injury, Surgery ,
Hepatitis
 FEATURES:
 Pain, fatigue
 Tender points
 Headaches; TMJ/
Facial pain
 Paraesthesias
 Sleep disturbances
 Brain fog/Fibrofog:
cognitive dysfunction
 Depression
OTHER SYMPTOMS:
 Irritable bowel syndrome
 Restless leg syndrome
 Temperature sensitivity
 GI complaints

 Skin Complaints
 Chest Symptoms
 Inco-ordination/
Imbalance
 Dysmenorrhea
 Dx – ACR CRITERIA 1990
 Chronic widespread pain for at least 3
months

 Pain in all 4 quadrants of the body; At least

one point in each quadrant

 Pain on digital palpation with a 4-kg force in

11/18 tender points
 MANAGEMENT
 Pharmaceutical:
- Analgesics
- Dopamine, serotonin
- Anti-depression, anti-seizure drugs
- Muscle relaxants
- CNS stimulants
 Non-drug Rx:
- Psychological/ behavioural therapy
 OBJECTIVE
 Effect of exercise training including
-Cardiorespiratory (aerobic)
-Muscle strengthening,
-and/or Flexibility exercise on:

 Global wellbeing,
 Selected signs and symptoms, and
 Physical function in individuals with FMS
 METHOD
 34 RCTs; 2276 subjects(1264)

 Inclusion criteria: ACR

 Exclusion criteria: medical conditions C/I

exs.
 PRIMARY OUTCOME MEASURES
1. Pain
2. Global well-being: Fibromyalgia Impact
Questionnaire (FIQ)
3. Physical function:
-Aerobic: 6MWT, Ergometer
-Strength: grip, hip/knee extension strength
-Flexibility: sit and reach test
4.Tender points: Dolorimetry, TP count

 SECONDARY OUTCOMES

5. Depression: Beck Depression Inventory

6. Fatigue and sleep: FIQ fatigue scale and sleep

VAS
 ACSM GUIDELINES 2006
AEROBIC TRAINING ×6wks
 F: 3/week
 I: 40% HRR (min-max: 40-85%) or 64%
predicted MHR (min-max: 64-94%)
 T: at least 20 mins duration
 T: use of major muscle groups
 Walking, cycling, swimming
 MUSCLE STRENGTHENING
 F: 2-3 days per week
 I: RM of each exercise
 T: min. of 1 set of 8-12 reps
 T: any type of strengthening exercise that
can be progressed over time
 Hip extn/abd/add.; Knee extn./flx.;

Upper limbs
 FLEXIBILITY TRAINING
 F: twice a week
 I: to a position of mild discomfort
 T: 3-4 reps for each stretch ×10-30 secs
 T: static stretching, AROM, neck and
extremity stretches
 RESULTS
AEROBIC ONLY:
 Positive effect : global well being and
physical function
 Insignificant on: pain, TP
 Conflicting: depression and fatigue

STRENGTH TRAINING:
 Limited evidence
FLEXIBILITY ONLY:
 Limited
 No effect on TP or depression

MIXED:
-inadequate number of studies
 IMPLICATIONS FOR PRACTICE
 Moderate quality evidence (aerobic)
- global outcome measures
- physical function
- possibly pain and tender points

 Limited evidence (strength)

-pain, global wellbeing, physical function, TP and
depression

 Insufficient evidence on effects of flexibility exercise