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Aerobic Exercise for Fibromyalgia: Effects, Side Effects, and Types

Performing aerobic exercise as one of the management of fibromyalgia is thought to improve the patient's quality of life, relieve pain intensity, and reduce muscle stiffness.

Aerobic Exercise for Fibromyalgia: Effects, Side Effects, and Types
Aerobic Exercise


What is Fibromyalgia? Fibromyalgia is a syndrome characterized by chronic pain that can occur throughout the body, tenderness, and muscle stiffness without an underlying organic disease. This syndrome can be accompanied by mood disorders, fatigue, insomnia, and cognitive impairment.

Definition Aerobic exercise is a physical exercise that causes the heart and lungs to work more intensely than when resting, such as walking, jogging, dancing, cycling, and swimming. Aerobic physical activity is defined as exercise is a physical activity that is repeated at least three times a week and more of 20 minutes. The intensity of aerobic exercise should reach a 40-85% heart rate reserve or 64-94% maximum heart rate.

There are several modalities for treating fibromyalgia. Pharmacologic therapies widely used for fibromyalgia are:
  • tricyclic antidepressants, 
  • pregabalin, 
  • cyclobenzaprine
  • serotonin-norepinephrine reuptake inhibitors (SNRIs), 
  • and selective serotonin reuptake inhibitors (SSRIs). 
Meanwhile, non-pharmacological management can be in the form of cognitive behavior therapy (CBT), physical exercise, and education.

Several international guidelines, namely those from the American Pain Society (APS) and the Association of the Scientific Medical Societies in Germany (AWMF), recommend aerobic exercise as one of the first-line therapies in fibromyalgia patients. In 2017, the European League Against Rheumatism (EULAR) also recommended aerobic and strength training to fibromyalgia patients with the recommended level Ia (grade A).


Effects of Aerobic Exercise on Fibromyalgia

Various studies studied the aerobic exercise effects on patients' quality of life (health-related life quality or HRLQ), pain intensity, muscle stiffness, physical function, and cardiorespiratory function.


Effects of Aerobic Exercise on Quality of Life

Several studies have found that aerobic exercise in fibromyalgia patients can improve the quality of life of sufferers by 7-8% compared to controls after 12-24 months. Kayo et al. conducted a study and found a significant difference in the quality of life at the evaluation 12 weeks after the completion of 16 weeks of aerobic exercise. However, the study of King et al. Evaluating 24 weeks after the end of aerobic exercise, found no significant difference in the quality of life.

Several studies were also conducted to compare fibromyalgia patients who received aerobic exercise with those receiving other non-pharmacological therapies. The effect of aerobic exercise, when compared with education, does not show conclusive results.


Effects of Aerobic Exercise on Clinical Symptoms

Compared with the control group, there was an 11% improvement in pain symptoms in patients after 6–24 weeks of aerobic exercise. Also, aerobic exercise slightly improves symptoms of muscle stiffness in fibromyalgia patients. Schachter et al. conducted a study and found an 8% improvement in patients' stiffness after 16 weeks of aerobic exercise.

But there is a meta-analysis of several studies that found that aerobic exercise did not show significant improvement in fatigue symptoms than the control group and compared to the group that received education and stress management training. However, the aerobic exercise showed a significant improvement in pain compared to education provision.

Studies have shown that aerobic exercise can improve patients' mood compared to a control group. However, aerobic exercise did not have a significant effect on patient sleep disorders.


Effects of Aerobic Exercise on Physical Function

Aerobic exercise in fibromyalgia patients reduced physical function limitations in patients by 10% compared to the control group after exercise for 8-24 weeks. Kayo et al. found that aerobic exercise showed improvement in the patient's physical function in the long term.


Effects of Aerobic Exercise on Cardiorespiratory Function

The study found that there was no difference in maximal cardiorespiratory function compared to the control group. However, there was a significant submaximal cardiorespiratory function improvement (on the six-minute walk test) compared to the control group. Long-term studies found no difference in cardiorespiratory function in fibromyalgia patients who received aerobic exercise.



Aerobic Exercise Side Effects

Several reports mention increased pain in patients after exercise. One study found about 17% of patients complained that aerobic exercise increased pain and fatigue. The study also found that some patients withdrew from the study because there was no improvement in symptoms.

In general, there were only 4 documented incidents of side effects associated with aerobic exercise. One patient had a metatarsal stress fracture, one patient had ischialgia, and two had transient knee pain. The study concluded that aerobic exercise is relatively safe to do without significant side effects.



Types of Aerobic Exercises Recommended for Fibromyalgia Patients

Currently, there are no guidelines regarding the aerobic exercise types that should be given to patients. In most studies, the type of exercise that is included is walking or cycling. Mannerkorpi et al. performed a study comparing Nordic walking exercise with another low-intensity aerobic exercise, but found no significant differences.

Schachter et al. found no significant differences in patient outcomes when comparing duration and frequency between various aerobic types. This study compared short-term low-intensity aerobic exercise (twice a week) with long-term exercise once a week.

Another meta-analysis found that it did not affect the type of aerobic exercise patients performed on the outcome. Patients doing exercises on lands such as jogging, walking, cycling, or dancing were compared with patients who exercised in water gave the same result. This meta-analysis concluded that fibromyalgia patients could consistently perform the aerobic exercise (on land and in water) consistently with moderate intensity, with a frequency of 2-3 times per week. Exercises must be carried out for at least 4 weeks.



Conclusion
Aerobic exercise can improve the quality of life for fibromyalgia patients and reduce the intensity of pain and muscle stiffness and improve physical function. However, further research on these benefits is still needed, given the many inconsistencies between current research results.

Currently, there is no sufficient data regarding the comparison of aerobic exercise with other non-pharmacological therapies or pharmacological therapies. However, because aerobic exercise is generally well tolerated and has no significant side effects, fibromyalgia patients may be advised to do moderate-intensity aerobic exercise 2–3 times per week for at least 4 weeks.

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