A Controlled Study of the Effects of a Supervised Cardiovascular Fitness Training Program on the Manifestations of Primary Fibromyalgia.

A Controlled Study of the Effects of a Supervised Cardiovascular Fitness Training Program on the Manifestations of Primary Fibromyalgia

McCain GA, Bell DA, Francois MM, et al (Div of Rheumatology and Psychiatry, Univ of Western Ontario, London, Ontario, Canada), Arthritis Rheum 31:1135-1141, 1988.

This paper reported the results of a randomized, controlled study of the effects of cardiovascular fitness training (CVR) on the manifestations of primary fibromyalgia syndrome. To test the hypothesis that CVR may improve the symptoms of fibromyalgia, 42 patients were accepted into the trial and randomly assigned either to a CVR training group or to a flexibility (FLEX) training group for a period of 20 weeks. Criteria for diagnosis of primary fibromyalgia syndrome were those described by Smythe. Nonsteroidal anti-inflammatory drugs, hypnotic drugs, and antidepressants were discontinued for at least three weeks before the trial period. Patients who had been treated with amitriptyline within three months were excluded from the study. Each subject completed a treadmill exercise stress test before randomization to a group in the study.

Patients in the CVR group were trained aerobically on a bicycle ergometer three times a week for 20 weeks. The FLEX group met at similar intervals but at different times, to ensure that the two groups never interacted. The same instructor guided both groups; however, members of the FLEX group were not allowed to increase their heart rates over 115 bpm.

Evaluation of subjects occurred at the baseline and during the 20-week period. The same two physicians examined the patients throughout the trial and were blinded to the type of exercise the patients received. Outcome measurements were obtained by questionnaire and examination. Patient assessment of pain, quality of sleep, and disease activity was completed using a visual analog scale, a pain diagram, and a questionnaire. Physician assessment of pain was completed by dolorimetry. The effect of each exercise program on cardiovascular fitness was assessed using a simple two-stage heart rate analysis as described by Astrand et al.

Thirty-eight patients completed the 20-week trial, with 18 receiving the CVR training and 20 receiving the FLEX training. After 20 weeks, patients receiving CVR training showed significantly improved cardiovascular fitness scores when compared with those receiving FLEX training (t[35] = -4.22, p [is greater than] .04). Also found was a clinical and statistically significant improvement in pain threshold scores that were measured directly over fibrositic tender points in patients undergoing CVR (t[35] = 2.21, p [is less than] .04). The CVR-trained patients improved significantly, both in patient and in physician global assessment scores, as compared with the FLEX group. The authors concluded that a supervised cardiovascular fitness training program might provide therapeutic benefit to selected patients with primary fibromyalgia syndrome.