title: Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial.
abstract: BACKGROUND
  Self-management has increasingly been recommended as part of standard care for fibromyalgia, a common, poorly understood condition with limited treatment options. Data that assess popular self-management recommendations are scarce. We evaluated and compared the effectiveness of 4 common self-management treatments on function, symptoms, and self-efficacy in women with fibromyalgia.
  
  
  METHODS
  A total of 207 women with confirmed fibromyalgia were recruited from September 16, 2002, through November 30, 2004, and randomly assigned to 16 weeks of (1) aerobic and flexibility exercise (AE); (2) strength training, aerobic, and flexibility exercise (ST); (3) the Fibromyalgia Self-Help Course (FSHC); or (4) a combination of ST and FSHC (ST-FSHC). The primary outcome was change in physical function from baseline to completion of the intervention. Secondary outcomes included social and emotional function, symptoms, and self-efficacy.
  
  
  RESULTS
  Improvements in the mean Fibromyalgia Impact Questionnaire score in the 4 groups were -12.7 for the ST-FSHC group, -8.2 for the AE group, -6.6 for the ST group, and -0.3 for the FSHC group. The ST-FSHC group demonstrated greater improvement than the FSHC group (mean difference, -12.4; 95% confidence interval [CI], -23.1 to -1.7). The ST-FSHC (mean difference, 13.6; 95% CI, 2.3 to 24.9) and AE (mean difference, 13.1; 95% CI, 1.6 to 25.6) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey. Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC (14.8), AE (13.2), and ST (5.7) groups. Social function, mental health, fatigue, depression, and self-efficacy also improved. The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months.
  
  
  CONCLUSIONS
  Progressive walking, simple strength training movements, and stretching activities improve functional status, key symptoms, and self-efficacy in women with fibromyalgia actively being treated with medication. The benefits of exercise are enhanced when combined with targeted self-management education. Our findings suggest that appropriate exercise and patient education be included in the treatment of fibromyalgia.
authors.affiliation: Novartis Institutes for Biomedical Research, Inc, Translational Medicine, 400 Technology Square, Cambridge, MA 02139, USA. daniel.rooks@novartis.com
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Rooks
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Matthew
authors.initials: M
authors.lastname: Romeling
authors.forename: Martha L
authors.initials: ML
authors.lastname: Cross
authors.forename: Diana
authors.initials: D
authors.lastname: Stratigakis
authors.forename: Brittany
authors.initials: B
authors.lastname: Evans
authors.forename: Don L
authors.initials: DL
authors.lastname: Goldenberg
authors.forename: Maura D
authors.initials: MD
authors.lastname: Iversen
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005081:Exercise Therapy; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D012648:Self Care; D016896:Treatment Outcome