Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials.
BACKGROUND
The efficacy and the optimal type and volume of aerobic exercise (AE) in fibromyalgia syndrome (FMS) are not established. We therefore assessed the efficacy of different types and volumes of AE in FMS.


METHODS
The Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDISCUS (through April 2009) and the reference sections of original studies and systematic reviews on AE in FMS were systematically reviewed. Randomised controlled trials (RCTs) of AE compared with controls (treatment as usual, attention placebo, active therapy) and head-to-head comparisons of different types of AE were included. Two authors independently extracted articles using predefined data fields, including study quality indicators.


RESULTS
Twenty-eight RCTs comparing AE with controls and seven RCTs comparing different types of AE with a total of 2,494 patients were reviewed. Effects were summarised using standardised mean differences (95% confidence intervals) by random effect models. AE reduced pain (-0.31 (-0.46, -0.17); P<0.001), fatigue (-0.22 (-0.38, -0.05); P=0.009), depressed mood (-0.32 (-0.53, -0.12); P=0.002) and limitations of health-related quality of life (HRQOL) (-0.40 (-0.60, -0.20); P<0.001), and improved physical fitness (0.65 (0.38, 0.95); P<0.001), post treatment. Pain was significantly reduced post treatment by land-based and water-based AE, exercises with slight to moderate intensity and frequency of two or three times per week. Positive effects on depressed mood, HRQOL and physical fitness could be maintained at follow-up. Continuing exercise was associated with positive outcomes at follow-up. Risks of bias analyses did not change the robustness of the results. Few studies reported a detailed exercise protocol, thus limiting subgroup analyses of different types of exercise.


CONCLUSIONS
An aerobic exercise programme for FMS patients should consist of land-based or water-based exercises with slight to moderate intensity two or three times per week for at least 4 weeks. The patient should be motivated to continue exercise after participating in an exercise programme.
Häuser
Winfried
W
Department of Internal Medicine I, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany. whaeuser@klinikum-saarbruecken.de
Klose
Petra
P
Langhorst
Jost
J
Moradi
Babak
B
Steinbach
Mario
M
Schiltenwolf
Marcus
M
Busch
Angela
A
D003863:Depression; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005221:Fatigue; D005356:Fibromyalgia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D010146:Pain; D011788:Quality of Life / Q000523:psychology; D012890:Sleep; D016896:Treatment Outcome
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003786
17943797
Arthritis Care Res. 1998 Jun;11(3):196-209
9782811
Arthritis Rheum. 1990 Feb;33(2):160-72
2306288
BMJ. 2002 Jul 27;325(7357):185
12142304
Rheumatology (Oxford). 2005 Apr;44(4):539-46
15695301
Arthritis Rheum. 1988 Sep;31(9):1135-41
3048273
Semin Arthritis Rheum. 2010 Jun;39(6):448-53
19250656
Arthritis Rheum. 2009 Feb 15;61(2):216-24
19177530
Scand J Rheumatol. 1996;25(2):77-86
8614771
Rheumatology (Oxford). 2000 May;39(5):501-5
10852980
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
19622511
Ann Rheum Dis. 2004 Mar;63(3):290-6
14962965
Schmerz. 2008 Jun;22(3):303-12
18449569
Clin J Pain. 1998 Sep;14(3):232-8
9758073
J Rheumatol. 1996 Jun;23(6):1050-3
8782139
Curr Opin Rheumatol. 2007 Mar;19(2):168-73
17278933
Rheumatol Int. 2004 Sep;24(5):272-7
14508601
Arthritis Rheum. 2004 Apr 15;51(2):184-92
15077258
Med Sci Sports Exerc. 2000 Oct;32(10):1691-7
11039639
Sleep Med. 2006 Apr;7(3):293-6
16564209
Med Sci Sports Exerc. 2007 Jul;39(7):1044-50
17596770
Ger Med Sci. 2008 Dec 09;6:Doc14
19675740
J Altern Complement Med. 2008 Oct;14(8):975-81
18990045
Arthritis Rheum. 2001 Feb;45(1):42-7
11308060
Clin Exp Rheumatol. 2007 Nov-Dec;25(6):823-30
18173915
J Rheumatol. 2002 Mar;29(3):575-81
11908576
Arthritis Rheum. 2002 Feb;47(1):22-8
11932874
Arthritis Rheum. 2006 Feb 15;55(1):66-73
16463415
Arthritis Care Res. 1999 Apr;12(2):120-8
10513500
Arthritis Rheum. 2004 Dec 15;51(6):890-8
15593364
Clin J Pain. 2005 Mar-Apr;21(2):166-74
15722810
Arthritis Rheum. 2006 Feb 15;55(1):57-65
16463414
Clinics (Sao Paulo). 2005 Apr;60(2):151-8
15880252
J Rheumatol. 1994 Apr;21(4):714-20
8035399
Arch Phys Med Rehabil. 2008 Dec;89(12):2250-7
19061736
J Phys Act Health. 2009 Mar;6(2):239-46
19420402
J Rheumatol. 2006 Feb;33(2):333-41
16465666
Clin Rheumatol. 2000;19(4):253-7
10941802
J Rehabil Med. 2008 Apr;40(4):248-52
18382819
Rheumatology (Oxford). 2005 Nov;44(11):1422-7
16030079
J Rheumatol. 2002 Dec;29(12):2620-7
12465163
Ann Rheum Dis. 2008 Apr;67(4):536-41
17644548
Scand J Rheumatol. 2002;31(5):306-10
12455823
J Rheumatol. 2000 Oct;27(10):2473-81
11036846
Phys Ther. 1994 Apr;74(4):327-32
8140145
Ann Rheum Dis. 2007 May;66(5):571-81
16916856
J Rehabil Med. 2002 May;34(3):119-27
12395939
Int J Technol Assess Health Care. 1990;6(1):5-30
2361819
Arthritis Rheum. 2005 Oct 15;53(5):724-31
16208640
Clin Exp Rheumatol. 1992 Jul-Aug;10(4):345-9
1395219
Arch Intern Med. 2007 Nov 12;167(20):2192-200
17998491
J Rheumatol. 2002 Mar;29(3):582-7
11908577
Rheumatol Int. 2008 Apr;28(6):527-32
17982749
Arch Phys Med Rehabil. 2008 Sep;89(9):1660-6
18675392
Arthritis Res Ther. 2008;10(1):R24
18294367
J Behav Med. 1998 Apr;21(2):163-78
9591168
J Rheumatol. 2003 May;30(5):1060-9
12734907
Rheumatol Int. 2008 Dec;29(2):147-52
18600327
Pain. 2009 Sep;145(1-2):69-81
19539427
Psychosom Med. 2003 Jul-Aug;65(4):528-33
12883101
Phys Ther. 2003 Apr;83(4):340-58
12665405
Rheum Dis Clin North Am. 2009 May;35(2):373-91
19647149
Phys Ther. 2008 Jul;88(7):857-71
18497301
Clin Rehabil. 2006 Oct;20(10):835-46
17008336
Arthritis Rheum. 2008 Feb;58(2):612-22
18240245
Expert Opin Pharmacother. 2006 Jun;7(8):1027-39
16722813
JAMA. 2009 Jan 14;301(2):198-209
19141768
Arthritis Rheum. 2001 Dec;45(6):519-29
11762686
Rheumatol Int. 2008 Jul;28(9):885-90
18278501
Arthritis Rheum. 2008 Oct 15;59(10):1399-406
18821656
Mymensingh Med J. 2005 Jul;14(2):141-4
16056199
Curr Opin Rheumatol. 2008 Mar;20(2):208-12
18349753