title: Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials.
abstract: 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.
authors.affiliation: Department of Internal Medicine I, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany. whaeuser@klinikum-saarbruecken.de
authors.forename: Winfried
authors.initials: W
authors.lastname: Häuser
authors.forename: Petra
authors.initials: P
authors.lastname: Klose
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Babak
authors.initials: B
authors.lastname: Moradi
authors.forename: Mario
authors.initials: M
authors.lastname: Steinbach
authors.forename: Marcus
authors.initials: M
authors.lastname: Schiltenwolf
authors.forename: Angela
authors.initials: A
authors.lastname: Busch
mesh_terms: 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
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003786
references.pmid: 17943797
references.citation: Arthritis Care Res. 1998 Jun;11(3):196-209
references.pmid: 9782811
references.citation: Arthritis Rheum. 1990 Feb;33(2):160-72
references.pmid: 2306288
references.citation: BMJ. 2002 Jul 27;325(7357):185
references.pmid: 12142304
references.citation: Rheumatology (Oxford). 2005 Apr;44(4):539-46
references.pmid: 15695301
references.citation: Arthritis Rheum. 1988 Sep;31(9):1135-41
references.pmid: 3048273
references.citation: Semin Arthritis Rheum. 2010 Jun;39(6):448-53
references.pmid: 19250656
references.citation: Arthritis Rheum. 2009 Feb 15;61(2):216-24
references.pmid: 19177530
references.citation: Scand J Rheumatol. 1996;25(2):77-86
references.pmid: 8614771
references.citation: Rheumatology (Oxford). 2000 May;39(5):501-5
references.pmid: 10852980
references.citation: Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
references.pmid: 19622511
references.citation: Ann Rheum Dis. 2004 Mar;63(3):290-6
references.pmid: 14962965
references.citation: Schmerz. 2008 Jun;22(3):303-12
references.pmid: 18449569
references.citation: Clin J Pain. 1998 Sep;14(3):232-8
references.pmid: 9758073
references.citation: J Rheumatol. 1996 Jun;23(6):1050-3
references.pmid: 8782139
references.citation: Curr Opin Rheumatol. 2007 Mar;19(2):168-73
references.pmid: 17278933
references.citation: Rheumatol Int. 2004 Sep;24(5):272-7
references.pmid: 14508601
references.citation: Arthritis Rheum. 2004 Apr 15;51(2):184-92
references.pmid: 15077258
references.citation: Med Sci Sports Exerc. 2000 Oct;32(10):1691-7
references.pmid: 11039639
references.citation: Sleep Med. 2006 Apr;7(3):293-6
references.pmid: 16564209
references.citation: Med Sci Sports Exerc. 2007 Jul;39(7):1044-50
references.pmid: 17596770
references.citation: Ger Med Sci. 2008 Dec 09;6:Doc14
references.pmid: 19675740
references.citation: J Altern Complement Med. 2008 Oct;14(8):975-81
references.pmid: 18990045
references.citation: Arthritis Rheum. 2001 Feb;45(1):42-7
references.pmid: 11308060
references.citation: Clin Exp Rheumatol. 2007 Nov-Dec;25(6):823-30
references.pmid: 18173915
references.citation: J Rheumatol. 2002 Mar;29(3):575-81
references.pmid: 11908576
references.citation: Arthritis Rheum. 2002 Feb;47(1):22-8
references.pmid: 11932874
references.citation: Arthritis Rheum. 2006 Feb 15;55(1):66-73
references.pmid: 16463415
references.citation: Arthritis Care Res. 1999 Apr;12(2):120-8
references.pmid: 10513500
references.citation: Arthritis Rheum. 2004 Dec 15;51(6):890-8
references.pmid: 15593364
references.citation: Clin J Pain. 2005 Mar-Apr;21(2):166-74
references.pmid: 15722810
references.citation: Arthritis Rheum. 2006 Feb 15;55(1):57-65
references.pmid: 16463414
references.citation: Clinics (Sao Paulo). 2005 Apr;60(2):151-8
references.pmid: 15880252
references.citation: J Rheumatol. 1994 Apr;21(4):714-20
references.pmid: 8035399
references.citation: Arch Phys Med Rehabil. 2008 Dec;89(12):2250-7
references.pmid: 19061736
references.citation: J Phys Act Health. 2009 Mar;6(2):239-46
references.pmid: 19420402
references.citation: J Rheumatol. 2006 Feb;33(2):333-41
references.pmid: 16465666
references.citation: Clin Rheumatol. 2000;19(4):253-7
references.pmid: 10941802
references.citation: J Rehabil Med. 2008 Apr;40(4):248-52
references.pmid: 18382819
references.citation: Rheumatology (Oxford). 2005 Nov;44(11):1422-7
references.pmid: 16030079
references.citation: J Rheumatol. 2002 Dec;29(12):2620-7
references.pmid: 12465163
references.citation: Ann Rheum Dis. 2008 Apr;67(4):536-41
references.pmid: 17644548
references.citation: Scand J Rheumatol. 2002;31(5):306-10
references.pmid: 12455823
references.citation: J Rheumatol. 2000 Oct;27(10):2473-81
references.pmid: 11036846
references.citation: Phys Ther. 1994 Apr;74(4):327-32
references.pmid: 8140145
references.citation: Ann Rheum Dis. 2007 May;66(5):571-81
references.pmid: 16916856
references.citation: J Rehabil Med. 2002 May;34(3):119-27
references.pmid: 12395939
references.citation: Int J Technol Assess Health Care. 1990;6(1):5-30
references.pmid: 2361819
references.citation: Arthritis Rheum. 2005 Oct 15;53(5):724-31
references.pmid: 16208640
references.citation: Clin Exp Rheumatol. 1992 Jul-Aug;10(4):345-9
references.pmid: 1395219
references.citation: Arch Intern Med. 2007 Nov 12;167(20):2192-200
references.pmid: 17998491
references.citation: J Rheumatol. 2002 Mar;29(3):582-7
references.pmid: 11908577
references.citation: Rheumatol Int. 2008 Apr;28(6):527-32
references.pmid: 17982749
references.citation: Arch Phys Med Rehabil. 2008 Sep;89(9):1660-6
references.pmid: 18675392
references.citation: Arthritis Res Ther. 2008;10(1):R24
references.pmid: 18294367
references.citation: J Behav Med. 1998 Apr;21(2):163-78
references.pmid: 9591168
references.citation: J Rheumatol. 2003 May;30(5):1060-9
references.pmid: 12734907
references.citation: Rheumatol Int. 2008 Dec;29(2):147-52
references.pmid: 18600327
references.citation: Pain. 2009 Sep;145(1-2):69-81
references.pmid: 19539427
references.citation: Psychosom Med. 2003 Jul-Aug;65(4):528-33
references.pmid: 12883101
references.citation: Phys Ther. 2003 Apr;83(4):340-58
references.pmid: 12665405
references.citation: Rheum Dis Clin North Am. 2009 May;35(2):373-91
references.pmid: 19647149
references.citation: Phys Ther. 2008 Jul;88(7):857-71
references.pmid: 18497301
references.citation: Clin Rehabil. 2006 Oct;20(10):835-46
references.pmid: 17008336
references.citation: Arthritis Rheum. 2008 Feb;58(2):612-22
references.pmid: 18240245
references.citation: Expert Opin Pharmacother. 2006 Jun;7(8):1027-39
references.pmid: 16722813
references.citation: JAMA. 2009 Jan 14;301(2):198-209
references.pmid: 19141768
references.citation: Arthritis Rheum. 2001 Dec;45(6):519-29
references.pmid: 11762686
references.citation: Rheumatol Int. 2008 Jul;28(9):885-90
references.pmid: 18278501
references.citation: Arthritis Rheum. 2008 Oct 15;59(10):1399-406
references.pmid: 18821656
references.citation: Mymensingh Med J. 2005 Jul;14(2):141-4
references.pmid: 16056199
references.citation: Curr Opin Rheumatol. 2008 Mar;20(2):208-12
references.pmid: 18349753