Exercise and global well-being in community-dwelling adults with fibromyalgia: a systematic review with meta-analysis.
BACKGROUND
Exercise has been recommended for improving global-well being in adults with fibromyalgia. However, no meta-analysis has determined the effects of exercise on global well-being using a single instrument and when analyzed separately according to intention-to-treat and per-protocol analyses. The purpose of this study was to fill that gap.


METHODS
Studies were derived from six electronic sources, cross-referencing from retrieved studies and expert review. Dual selection of randomized controlled exercise training studies published between January 1, 1980 and January 1, 2008 and in which global well-being was assessed using the Fibromyalgia Impact Questionnaire (FIQ) were included. Dual abstraction of data for study, subject and exercise program characteristics as well as assessment of changes in global well-being using the total score from the FIQ was conducted. Risk of bias was assessed using the Cochrane bias assessment tool. Random-effects models and Hedge's standardized effect size (g) were used to pool results according to per-protocol and intention-to-treat analyses.


RESULTS
Of 1,025 studies screened, 7 representing 5 per-protocol and 5 intention-to-treat outcomes in 473 (280 exercise, 193 control) primarily female (99%) participants 18-73 years of age were included. Small, statistically significant improvements in global well-being were observed for per-protocol (g and 95% confidence interval, -0.39, -0.69 to -0.08) and intention-to-treat (-0.34, -0.53 to -0.14) analyses. No statistically significant within-group heterogeneity was found (per-protocol, Qw = 6.04, p = 0.20, I2 = 33.8%; intention-to-treat, Qw = 3.19, p = 0.53, I2 = 0%) and no between-group differences for per-protocol and intention-to-treat outcomes were observed (Qb = 0.07, p = 0.80). Changes were equivalent to improvements of 8.2% for per-protocol analyses and 7.3% for intention-to-treat analyses.


CONCLUSIONS
The results of this study suggest that exercise improves global well-being in community-dwelling women with fibromyalgia. However, additional research on this topic is needed, including research in men as well as optimal exercise programs for improving global well-being in adults.
Kelley
George A
GA
Department of Community Medicine, West Virginia University, Morgantown, West Virginia, USA. gkelley@hsc.wvu.edu
Kelley
Kristi S
KS
Hootman
Jennifer M
JM
Jones
Dina L
DL
D000328:Adult; D005081:Exercise Therapy; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D006304:Health Status; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D012111:Residence Characteristics
Health Qual Life Outcomes. 2006 Dec 07;4:94
17156420
J Occup Environ Med. 2008 Jan;50(1):13-24
18188077
Am J Med. 1982 Feb;72(2):233-40
7058834
Arthritis Care Res. 1998 Jun;11(3):196-209
9782811
Clin Exp Rheumatol. 2007 Nov-Dec;25(6):823-30
18173915
Biometrics. 2000 Jun;56(2):455-63
10877304
J Rheumatol. 2009 Jun;36(6):1304-11
19369473
JAMA. 1995 Feb 1;273(5):408-12
7823387
Arch Phys Med Rehabil. 2005 Sep;86(9):1713-21
16181932
Int J Clin Pract. 2007 Sep;61(9):1498-508
17655684
Ann Rheum Dis. 2001 Jan;60(1):21-6
11114277
Pain. 2001 Nov;94(2):149-158
11690728
Biometrics. 1977 Mar;33(1):159-74
843571
J Pain Palliat Care Pharmacother. 2002;16(3):91-8
14640361
JAMA. 1999 Sep 15;282(11):1054-60
10493204
Rheumatology (Oxford). 2004 Feb;43(2):225-8
13130154
BMJ. 2009 Sep 07;339:b3244
19736281
Med Sci Sports Exerc. 2007 Jul;39(7):1044-50
17596770
Phys Ther. 2001 Oct;81(10):1719-30
11589645
Rheumatol Int. 2009 Jan;29(3):267-73
18682951
Rheumatology (Oxford). 2005 Nov;44(11):1422-7
16030079
J Rheumatol. 2002 Dec;29(12):2620-7
12465163
Arthritis Rheum. 2008 Jan;58(1):26-35
18163497
Scand J Med Sci Sports. 2006 Feb;16 Suppl 1:3-63
16451303
J Rheumatol. 2008 Jun;35(6):1130-44
18464301
Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S154-62
16273800
Phys Ther. 2003 Apr;83(4):340-58
12665405
Qual Life Res. 1998 Jan;7(1):57-65
9481151
Control Clin Trials. 1990 Oct;11(5):339-52
1963128
J Clin Epidemiol. 1995 Jan;48(1):45-57; discussion 59-60
7853047
Psychol Bull. 1968 Oct;70(4):213-20
19673146
BMJ. 2009 Oct 19;339:b4012
19841007
J Clin Epidemiol. 1992 Jul;45(7):769-73
1619456
J R Soc Med. 2003 Jan;96(1):17-22
12519797
Arthritis Rheum. 2001 Dec;45(6):519-29
11762686
Med Sci Sports Exerc. 2007 Aug;39(8):1423-34
17762377
Psychol Bull. 1992 Jul;112(1):155-9
19565683
Med Sci Sports Exerc. 2007 Aug;39(8):1435-45
17762378
BMJ. 2003 Sep 6;327(7414):557-60
12958120