Exercise as it relates to Disease/Exercise as relief of stress-related fibromyalgia

Background
Fibromyalgia is a blanket term for generalised pain and stiffness in the muscles as well as lethargy and poor quality sleep. It is thought that the cause of Fibromyalgia originates in the brain and has been linked to sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome and multiple chemical sensitivities. Research into alleviating symptoms is crucial as it affects around 2-5% of the population with high prevalence in young to middle aged womenFibromyalgia [Internet]. Healthdirect.gov.au. 2020 [cited 17 September 2020]. Available from: https://www.healthdirect.gov.au/fibromyalgia. As this affects a large number of individuals and is a physical and psychological impairment, it is essential to look into the effects exercise as well as stress management treatment can have on relieving symptoms.

Where is the research from?
The chosen article was published in the Scandinavian Journal of Rheumatology published online in 2009 by S. H⊘rven Wigers, T. C. Stiles & P. A. Vogel. The research posted is peer reviewed and is published in a reputable journal illustrating that the content is high quality. The research was conducted at the University of Oslo, Norway in the Department of Physical Medicine and Rehabilitation, University Hospital of Trondheim, Department of Psychiatry and Behavioral Medicine, University of Trondheim, Department of Behavioral Sciences in Medicine.

What kind of research was this?
The research is a four and a half year prospective study by which sixty five fibromyalgia patients from the local patient association underwent an extensive medical history. To ensure comparability to other literature the participants had to fulfill a certain diagnostic criteria making the study more valid. The use of the four and a half year study successfully allows the study to demonstrate whether the chronic effects of fibromyalgia are still present and which intervention was more successful. Although given the layout of prospective study it relies on the participants own tenacity in regards to following their intervention which may skew results but in this case almost identical completion rate occurred.

What did the research involve?
The exercise intervention group underwent three, forty five minute sessions over fourteen weeks which equates to just under the weekly physical activity guidelines. Participants were guided by physiotherapists by which they underwent exercises to minimise whole body eccentric muscle strain, their programs then progressed via their individual biomarkers. Each individual was fitted with the same shoes as well as followed the same warm up and cooldown routines allowing the design to become more valid. The stress management treatment consisted of two clinical psychologists one working in a group setting and the other working closely with the participant. Each individual underwent ninety minutes twice a week for the first six weeks and then once a week for the remaining eight weeks, they were given cognitive behavioural stress therapy and an introduction to cognitive therapy in coping with psychological problems. As these were designed to be quickly applied to any situation the participants would likely not become overwhelmed ultimately leading to a decrease in fibromyalgia. Outcome Assessments were made to establish baseline, midway and after as well as a four year follow up after the intervention. All the assessments were made at a practitioner besides the midway assessment which consisted of a self directed questionnaire. Given both the professional and self administered evaluation the information given can meet a balance between anecdotal feedback and practitioner assessment allowing for a more accurate scope of information.

What were the basic results?
Between both the aerobic exercise groups and the stress management group there were no significant differences from each other but in comparison to the control group who continued their treatment as usual, there were a number of differences which indicate positive signs for short term relief of symptoms.

Aerobic group
The aerobic group showed consequential results reduced pain distribution, tender point pain as well as a greater capacity to work. In addition, participants also demonstrated increased energy as well as increased subjective societal improvements. Interestingly, the participants rated improved physical fitness and the positive social dimension as the most beneficial aspects of the treatment.

Stress
The Stress management showed reduced tenderness as a result of the treatment as well as decreased depression and decreased in disturbed sleep. These participants found that the most beneficial skill was learning relaxation techniques.

Conclusions
The study demonstrates that both aerobic exercise and stress management illicit positive short term effects on fibromyalgia in comparison to the regular treatment, However in more research must be done on this as when looking at each group as a whole there were no significant long term decreases in severity of symptoms. Symptoms were reduced when participants adhered to their program with exercise, which could potentially account for the lack of long term results further advising more studies to be done. In addition, given the effects of exercise are reversibile it is likely that the positive effects on fibromyalgia are also reversible which further reiterates that compliance towards one's program is crucial to reducing symptoms. Furthermore the stress management had a higher compliance rate long term than exercise as well as helping with pain management and depression which aligns with other literature. As both groups demonstrated improvements over the baseline one can deduce that there are beneficial short term consequences, but in terms of long term symptoms more research is needed. The differences between each participants everyday stressors may limit the effects of each individual's treatment.

Practical advice
Both modes of pain management have beneficial implications in the daily life of chronic sufferers. Both techniques offer a cost effective way to reduce the pain from symptoms when compared to the regular treatment and should be considered by all chronic sufferers to improve their quality of life. A combination of both exercise and stress management could have great implications in the daily life of fibromyalgia patients addressing both the physical and psychological aspects of the disease. In addition more research should be done in addressing the long term improvements but if both exercise and stress managements can dull the pain and allow patients to have a greater work capacity one should converse with their physician about potentially prescribing an intervention plan.

Here are some further supporting documents
Exercise

Stress-managment 
 * Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study.
 * Exercise for Fibromyalgia: A Systematic Review
 * Exercise Therapy for Fibromyalgia
 * A Controlled Study of a Stress-Reduction, Cognitive-Behavioral Treatment Program in Fibromyalgia