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Pool Therapy Effective for Fibromyalgia
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Posted on: 12/22/2008
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People around the world suffer from the global (many different) symptoms of fibromyalgia. In this report from Spain, the effects of an aquatics program are measured in women with fibromyalgia compared with a healthy women of the same age, weight, education, and physical fitness). No one in the control group had fibromyalgia, symptoms of fibromyalgia, or any other known illness. The goal was to see how exercising in warm water affects the global symptoms of fibromyalgia.
Fibromyalgia or fibromyalgia syndrome (FMS) is a chronic muscle pain syndrome. It is characterized as pain or tender points that is widespread throughout the body. FMS was originally put under the category of rheumatology (arthritic conditions). New understanding of FMS with documented objective biochemical, endocrine, and physiologic abnormalities puts it more in a biologic (organic) category.
It has been described as a disorder associated with neurohormonal dysfunction of the autonomic nervous system (ANS). The autonomic nervous system is the part of your nervous system that controls unconscious functions like breathing, heartbeat, blood pressure, and body temperature.
Many studies have shown that physical activity and exercise are very helpful for patients with fibromyalgia syndrome. They report decreased pain, improved sleep, better quality of life, and even improved cognitive function.
In this study, women in the fibromyalgia group were divided into two groups. One group participated in a three-times-a-week, 16-week exercise therapy program in a pool of chest-high warm water. The program included warm ups, strength exercises, aerobic exercise, and a cool down period. Heart rate was monitored throughout the program. The second group of women with fibromyalgia was told to continue their normal activities but not to add any new activities or exercise.
In addition to looking at the effects of the exercise, the researchers followed the group for a full year to see what kind of adherence there was. Adherence refers to how many women kept participating in a pool therapy program once the study had ended.
Effects of the program were measured using tender point count, health status, physical endurance, anxiety, and cognitive function. Various questionnaires (e.g., State Anxiety Inventory, Pittsburgh Sleep Quality Index, Fibromyalgia Impact Questionnaire) were used to assess each of these areas. Each woman in the study completed the surveys before and after the exercise program.
The authors discuss the difficulty of testing patients with fibromyalgia. Measuring pain using a verbal report of present/absent or giving pain a rating from zero (no pain) to 10 (maximum pain) is not an adequate measure of exercise-induced effects. The results of other studies using these measures reported no observed changes.
At the same time, physical function is limited in patients with fibromyalgia. Testing in any meaningful fashion can result in increased pain and a set back in their health status. The use of a metronome to control the pace of movement while performing a test called the chair-stand test was presented. Patients were instructed to stand up and sit down in time to the beat of the metronome. The ticking of the metronome could be set so that patients got an aerobic effect without compromising the results of the test.
In the pre-testing results, they found that the fibromyalgia group was very deficient in all areas compared to the normal, healthy group. After the 16-week program, there were no changes in the control group (group that did NOT do the pool program). The exercise group did have significant improvement in pain levels, sleep quality, and physical and cognitive function. However, there was no change in anxiety level after exercise.
The authors note that not all of the improvement in health status could be linked with the exercise therapy. The change in season from before (January) and after the program (May) may have had an effect. The beneficial effect of warm weather on fibromyalgia has been pointed out in previous studies.
There was a very low dropout rate from the exercise group. Reasons given were related to problems with transportation and work schedules. And at the end of a year, 79 per cent of the women in the exercise group continued to exercise. Most of the women continued in the pool therapy program. A few others chose a different form of exercise.
The conclusion from this study was that an aquatic program of exercise is beneficial for fibromyalgia patients. There were no negative effects and many positive results of the exercise. And it's a type of exercise they are likely to continue.
Exercise of any kind can help reduce or minimize deconditioning. Further studies are needed to assess the long-term results (i.e., how long do the exercise-induced changes last?). And the authors suggest looking into other forms of exercise to find the one most likely to encourage patients to maintain an exercise program for life.
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References:
Diego Munguía-Izquierdo, PhD, and Alehandro Legaz-Arrese, PhD. Assessment of the Effects of Aquatic Therapy on Global Symptomatology in Patients with Fibromyalgia Syndrome: A Randomized Controlled Trial. In Archives of Physical Medicine and Rehabilitation. December 2008. Vol. 89. No. 12. Pp. 2250-2257.
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