In the EULAR Guidelines for the Management of FM, under specific considerations for the non-pharmacological management of FM, it includes:
- Heated pool treatment, with or without exercise, is effective.
- For some patients with FMS, individually tailored exercise programs can be helpful. These may include aerobic exercise and strength training.
Two articles have been e-published ahead of print recently that deal with warm water therapy and exercise for FM.
The article ‘Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study’, which will be published in the journal Rheumatology International, comes from a group of researchers (Evcik D, Yigit I, Pusak H, Kavuncu V) at the Department of Physical Rehabilitation Medicine, Ufuk University, Turkey.
The study aimed to investigate the efficacy of aquatic exercises in fibromyalgia syndrome. Sixty-three patients were allocated to two groups: Group I, which received an aquatic exercise program; and Group II, which received a home-based exercise program. The exercise programs were for 60 minutes, 3 times a week, over 5 weeks.
Patients were evaluated for pain (visual analogue scale, VAS), number of tender points (NTP), Beck depression inventory (BDI), and functional capacity (fibromyalgia impact questionnaire, FIQ). These parameters were measured before the start of the study and at weeks 4, 12, and 24.
The study found that there were statistically significant differences in FIQ and NTP in both groups at the end and during follow-up. Group I showed a statistically significant decrease in BDI scores after 4 and 12 weeks that remained after 24 weeks. In Group II, a significant decrease in BDI scores was observed at the end and during follow-up. Also, a significant improvement was found in VAS at weeks 4 and 12 in both groups. The average reduction in pain scores was 40% in Group I and 21% in Group II. However, this reduction in pain scores was still significant at week 24 in the aquatic therapy group only. A comparison of the two groups showed no statistically significant difference for FIQ, NTP, and BDI scores except VAS.
The researchers said in the article that:
“[the] results showed that both aquatic therapy and home-based exercise programs have beneficial effects on FIQ, BDI, and NTP. In pain management, only aquatic therapy seems to have long-term effects.”
The second article, ‘Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial’, which will be published in Arthritis Research and Therapy, (by Gusi N, Tomas-Carus P) was on a study that aimed to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia.
The study included 33 participants, who were randomly assigned to either an experimental group or a control group and considered the costs to the health care system and to society. The intervention in the experimental group consisted of a one-hour, supervised, water-based exercise sessions, three times per week for 8 months.
The main outcome measures were the health care costs and the number of quality-adjusted life-years (QALYs) using the time trade-off elicitation technique from the EQ-5D. Sensitivity analyses was performed for variations in the staff salary, number of women attending sessions and time spent going to the pool. The cost-effectiveness acceptability curves were created using a non-parametric bootstrap technique.
The mean incremental treatment costs exceeded those for usual care per patient by 517 Euros for health care costs and 1032 Euros for societal costs. The mean incremental QALY associated with the intervention was 0.131. Each QALY gained in association with the exercise programme cost an additional 3947 Euro/QALY from a health care perspective and 7878 Euro/QALY from a societal perspective.
The researchers concluded that the addition of an aquatic exercise programme to the usual care for fibromyalgia in women, is cost-effective in terms of both health care costs and societal costs. However, the characteristics of facilities (distance from the patients homes and number of patients that can be accommodated per session) are major determinants to consider before investing in such a programme.
