Ottawa Panel evidence-based clinical practice guidelines for aerobic fitness exercises in the management of fibromyalgia: part 1.
OBJECTIVE
The objective of this study was to create guidelines for the use of aerobic fitness exercises in the management of adult patients (>18 years of age) with fibromyalgia, as defined by the 1990 American College of Rheumatology criteria.


METHODS
Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 13 randomized control trials and 3 controlled clinical trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found.


RESULTS
There were 24 positive recommendations: 10 grade A, 1 grade B, and 13 grade C+. Of these 24 positive recommendations, only 5 were of clinical benefit.


CONCLUSIONS
The Ottawa Panel recommends aerobic fitness exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.
Brosseau
Lucie
L
Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. Lucie.Brosseau@uottawa.ca
Wells
George A
GA
Tugwell
Peter
P
Egan
Mary
M
Wilson
Keith G
KG
Dubouloz
Claire-Jehanne
CJ
Casimiro
Lynn
L
Robinson
Vivian A
VA
McGowan
Jessie
J
Busch
Angela
A
Poitras
Stéphane
S
Moldofsky
Harvey
H
Harth
Manfred
M
Finestone
Hillel M
HM
Nielson
Warren
W
Haines-Wangda
Angela
A
Russell-Doreleyers
Marion
M
Lambert
Kim
K
Marshall
Alison D
AD
Veilleux
Line
L
D000328:Adult; D002170:Canada; D019317:Evidence-Based Medicine; D015444:Exercise; D005081:Exercise Therapy; D005356:Fibromyalgia / Q000534:rehabilitation*; D006801:Humans; D017410:Practice Guidelines as Topic