title: A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia.
abstract: OBJECTIVE
  To compare the therapeutic effects of physical fitness training or biofeedback training with the results of usual care in patients with fibromyalgia (FM).
  
  
  METHODS
  One hundred forty-three female patients with FM (American College of Rheumatology criteria) were randomized into 3 groups: a fitness program (n = 58), biofeedback training (n = 56), or controls (n = 29). Half the patients in the active treatment groups also received an educational program aimed at improving compliance. Assessments were done at baseline and after 24 weeks. The primary outcome was pain [visual analog scale (VAS)]. Other endpoints were the number of tender points, total myalgic score (dolorimetry), physical fitness, functional ability (Arthritis Impact Measurement Scale and Sickness Impact Profile), psychological distress (Symptom Checklist-90-Revised), patient global assessment (5 point scale), and general fatigue (VAS).
  
  
  RESULTS
  Baseline scores were similar in all 3 groups. Altogether 25 (17.5%) patients dropped out; they were similarly distributed over all groups: 14 patients after randomization and 11 (8%) during the study. A true high impact level for fitness training was not attained by any patient. After treatment, no significant differences in change scores of any outcome were found between the groups (ANOVA, p > 0.05). All outcome measures showed large variations intra- and interindividually. The educational program did not result in higher compliance with training sessions (62% vs 71%). Analysis of the subgroup of subjects with a high attendance rate (> 67%) also showed no improvement.
  
  
  CONCLUSIONS
  In terms of training intensity and maximal heart rates, the high impact fitness intervention had a low impact benefit. Therefore effectiveness of high impact physical fitness training cannot be demonstrated. Thus compared to usual care, the fitness training (i.e., low impact) and biofeedback training had no clear beneficial effects on objective or subjective patient outcomes in patients with FM.
authors.affiliation: Department of Internal Medicine, University Hospital Maastricht, The Netherlands. msa@sint.azm.nl
authors.forename: Marijke
authors.initials: M
authors.lastname: van Santen
authors.forename: Paulien
authors.initials: P
authors.lastname: Bolwijn
authors.forename: Frans
authors.initials: F
authors.lastname: Verstappen
authors.forename: Carla
authors.initials: C
authors.lastname: Bakker
authors.forename: Alita
authors.initials: A
authors.lastname: Hidding
authors.forename: Harry
authors.initials: H
authors.lastname: Houben
authors.forename: Desiree
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.forename: Sjef
authors.initials: S
authors.lastname: van der Linden
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology; D015444:Exercise; D005081:Exercise Therapy; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D010353:Patient Education as Topic; D010809:Physical Fitness; D015203:Reproducibility of Results; D016896:Treatment Outcome