Accumulating 30 minutes a day of "lifestyle" physical activity, by walking more, using the stairs, or gardening, for example, led to significant improvements in perceived physical functioning and reduced pain in a study of previously minimally active adults with fibromyalgia, researchers report.
"People with fibromyalgia are very sedentary because its major symptoms — pain and fatigue — make it difficult to become or stay physically active," Kevin R. Fontaine, PhD, associate professor of medicine in the Department of Health, Behavior, and Society at Johns Hopkins University School of Medicine in Baltimore, Maryland, noted in an email to Medscape Psychiatry.
The current study, Dr. Fontaine added, suggests that "even if they cannot engage in traditional exercise, they can derive some benefits from simply incorporating short bouts of physical activity into their daily lives."
Their findings are reported in BioMedCentral's open access journal Arthritis Research & Therapy, published online March 29.
Active Living Every Day
In the study, Dr. Fontaine and colleagues evaluated the effects of increasing daily lifestyle physical activity (LPA) in a randomized controlled study involving 84 middle-aged, largely female adults who had fibromyalgia for a mean of 7.5 years. The subjects were not getting regular physical activity, but they had no acute or chronic medical conditions precluding them from being active.
The 46 subjects assigned to the LPA group were encouraged to work toward accumulating 30 minutes of self-selected moderate-intensity LPA, 5 to 7 days per week, for 12 weeks. By week 5, most were achieving this goal.
The LPA protocol was loosely based on Active Living Every Day, a cognitive-behavioral physical activity promotion program developed at the Cooper Aerobics Center, and addressed fibromyalgia-specific challenges to becoming more physically active, the researchers explain.
The remaining 38 subjects assigned to a fibromyalgia education group received information and support only. Seventy-three of the 84 subjects (87%) completed the 12-week study.
Pedometers worn by participants in the LPA group showed that they increased their mean number of daily steps from 3788 at baseline to 5837 at the end of the study (P = .001). "By asking people to simply try to accumulate short bouts of LPA throughout the day, we were able to increase their average daily steps of the LPA group by 54% over the 12-week study," Dr. Fontaine noted.
"The LPA group, likely as the result of becoming more physically active, significantly improved their perceived physical functioning and reduced their pain compared to a group of patients who participated in an education/support group," the researchers added.
Specifically, compared with the control group, the LPA group reported significantly less perceived functional deficits (P = .032) on the Fibromyalgia Impact Questionnaire (FIQ) and significantly less pain (P = .006) on the visual analogue scale (VAS) at the end of the study period. The magnitude of the postintervention differences, expressed as percent change from LPA to control groups, was 18% for the FIQ score and 35% for the pain VAS score, the study authors note, which are indicative of "medium-sized effects."
There were no between-group differences on the 6-minute walk test (P = .067) or in fatigue, depression, body mass index, or number of tender points.
"Modest But Positive" Improvement
In an email to Medscape Psychiatry, Angela J. Busch, PhD, and Candice L. Schachter, PhD, from the School of Physical Therapy, University of Saskatchewan in Saskatoon, Canada, noted that although the study "is not without its share of methodological weaknesses ... it is impressive that clinical meaningful improvement in fibromyalgia symptoms were observed in this less structure form of physical activity. [The] findings are consistent with studies of aerobic exercise for those with fibromyalgia showing improvements that are modest but positive."
Dr. Busch and Dr. Schachter, who were not involved in the study, said, "Adoption and long term maintenance of such lifestyle physical activity holds promise for both improvements in some fibromyalgia symptoms and accumulation of general health benefits and so merits future investigation."
Dr. Fontaine has disclosed no relevant financial relationships. A coauthor discloses having acted as a consultant for Pfizer, Lilly, Forest Labs, Cypress Biosciences, Pierre Fabre, UCB, and Wyeth and has received grant support from Pfizer, Cypress Bioscience, and Forest. Dr. Busch and Dr. Schachter have disclosed no relevant financial relationships.
Arthritis Res Ther. Published online March 29, 2010.
Megan Brooks, April 1, 2010 • Medscape Medical News © 2010 Medscape, LLC