title: A six-month randomized controlled trial of exercise and pyridostigmine in the treatment of fibromyalgia. The health effects of at-home written emotional disclosure in fibromyalgia: A randomized trial Effects of Functional Interactivity on Patients’ Knowledge, Empowerment, and Health Outcomes: An Experimental Model-Driven Evaluation of a Web-Based Intervention Effect of pilates training on people with fibromyalgia syndrome: a pilot study. Sustained Pain Reduction Through Affective Self-awareness in Fibromyalgia: A Randomized Controlled Trial Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients Effects of a one week multidisciplinary inpatient self-management programme for patients with fibromyalgia: a randomised controlled trial Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial Six-and 12-month follow-up of an interdisciplinary fibromyalgia treatment programme: results of a randomised trial. Effect of Moderate to Vigorous Physical Activity Intervention on Improving Dementia Family Caregiver Physical Function: A Randomized Controlled Trial A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia Effects of yoga and the addition of Tui Na in patients with fibromyalgia. Combining Cognitive-Behavioral Therapy and Milnacipran for Fibromyalgia: A Feasibility Randomized-controlled Trial Effects of resistance training and chiropractic treatment in women with fibromyalgia. Effects of guided imagery on biobehavioral factors in women with fibromyalgia Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia Research to Encourage Exercise for Fibromyalgia (REEF): Use of Motivational Interviewing, Outcomes From a Randomized-controlled Trial Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. Effects of a prolonged exercise program on key health outcomes in women with fibromyalgia: a randomized controlled trial. Effect of a 24-week physical training programme (in water and on land) on pain, functional capacity, body composition and quality of life in women with fibromyalgia. Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? Effects of Lifestyle Physical Activity in Adults With Fibromyalgia: Results at Follow-Up Written Emotional Expression Produces Health Benefits in Fibromyalgia Patients An Online Mindfulness Intervention Targeting Socioemotional Regulation in Fibromyalgia: Results of a Randomized Controlled Trial
abstract: OBJECTIVE A subset of fibromyalgia ( FM ) patients have a dysfunctional hypothalamic-pituitary-insulin-like growth factor 1 ( IGF-1 ) axis , as evidence d by low serum levels of IGF-1 and a reduced growth hormone ( GH ) response to physiologic stimuli . There is evidence that pyridostigmine ( PYD ) improves the acute response of GH to exercise in FM patients . The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on FM symptoms . METHODS FM patients were r and omized to 1 of the following 4 groups : PYD plus exercise , PYD plus diet recall but no exercise , placebo plus exercise , and placebo plus diet recall but no exercise . The primary outcome measures were the visual analog scale ( VAS ) score for pain , tender point count , and total myalgic score . Secondary outcome measures were the total score on the Fibromyalgia Impact Question naire ( FIQ ) and FIQ VAS scores for individual symptoms ( fatigue , poor sleep , stiffness , and anxiety ) , as well as quality of life ( QOL ) and physical fitness ( lower body strength/endurance , upper and lower body flexibility , balance , and time on the treadmill ) . RESULTS A total of 165 FM patients completed baseline measurements ; 154 ( 93.3 % ) completed the study . The combination of PYD and exercise did not improve pain scores .  PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups . Compared with the nonexercise groups , the 2 exercise groups demonstrated improvement in fatigue and fitness .  PYD was generally well tolerated . CONCLUSION Neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most FM symptoms . However , PYD did improve anxiety and sleep , and exercise improved fatigue and fitness . We speculate that PYD may have improved vagal tone , thus benefiting sleep and anxiety ; this notion warrants further study Background : The presence and severity of the chronic pain syndrome fibromyalgia ( FM ) is associated with unresolved stress and emotional regulation difficulties . Written emotional disclosure is intended to reduce stress and may improve health of people with FM . Purpose : This study tests the effects of at-home , written emotional disclosure about stressful experiences on the health of people with FM and uses multiple follow-ups to track the time course of effects of disclosure . Methods : Adults with FM ( intention-to-treat , n = 83 ; completers , n = 72 ) were r and omized to write for 4 days at home about either stressful experiences ( disclosure group ) or neutral time management ( control group ) . Group differences in immediate mood effects and changes in health from baseline to 1-month and 3-month follow-ups were examined . Results : Written disclosure led to an immediate increase in negative mood , which did not attenuate across the 4 writing days . Repeated- measures analyses from baseline to each follow-up point were conducted on both intention-to-treat and completer sample s , which showed similar outcomes . At 1 month , disclosure led to few health benefits , but control writing led to less negative affect and more perceived support than did disclosure . At 3-month follow-up , these negative affect and social support effects disappeared , and written disclosure led to a greater reduction in global impact , poor sleep , health care utilization , and ( marginally ) physical disability than did control writing . Interpretation of these apparent benefits needs to be made cautiously , however , because the disclosure group had somewhat poorer health than controls at baseline and the control group showed some minor worsening over time . Conclusions : Written emotional disclosure can be conducted at home , and there is tentative evidence that disclosure benefits the health of people with FM . The benefits , however , may be delayed for several months after writing and may be of limited clinical significance Background The effectiveness of eHealth interventions in terms of reach and outcomes is now well documented . However , there is a need to underst and not only whether eHealth interventions work , but also what kind of functions and mechanisms enhance their effectiveness . The present investigation contributes to tackling these challenges by investigating the role played by functional interactivity on patients ’ knowledge , empowerment , and health outcomes . Objectives To test whether health knowledge and empowerment mediate a possible relationship between the availability of interactive features on an eHealth application and individuals ’ health outcomes . We present an empirical , model-driven evaluation of the effects of functional interactivity implemented in an eHealth application , based on a brief theoretical review of the constructs of interactivity , health knowledge , empowerment , and health outcomes . We merged these constructs into a theoretical model of interactivity effects that we tested on an eHealth application for patients with fibromyalgia syndrome ( FMS ) . Methods This study used a pretest – posttest experimental design . We recruited 165 patients and r and omly assigned them to three study groups , corresponding to different levels of functional interactivity .  Eligibility to participate in the study required that patients ( 1 ) be fluent in Italian , ( 2 ) have access to the Internet , ( 3 ) report confidence in how to use a computer , and ( 4 ) have received a diagnosis of FMS from a doctor . We used structural equation modeling techniques to analyze changes between the pretest and the posttest results . Results The main finding was that functional interactivity had no impact on empowerment dimensions , nor direct observable effects on knowledge . However , knowledge positively affected health outcomes ( b = –.12 , P = .02 ) , as did the empowerment dimensions of meaning ( b = –.49 , P < .001 ) and impact ( b = –.25 , P < .001 ) . Conclusion The theoretical model was partially confirmed , but only as far as the effects of knowledge and empowerment were concerned . The differential effect of interactive functions was by far weaker than expected . The strong impact of knowledge and empowerment on health outcomes suggests that these constructs should be targeted and enhanced by eHealth applications UNLABELLED Altan L , Korkmaz N , Bingol U , Gunay B. Effect of Pilates training on people with fibromyalgia syndrome : a pilot study . OBJECTIVE To investigate the effects of Pilates on pain , functional status , and quality of life in fibromyalgia , which is known to be a chronic musculoskeletal disorder . DESIGN R and omized , prospect i ve , controlled , and single-blind trial . SETTING Physical medicine and rehabilitation department . PARTICIPANTS Women ( N=50 ) who had a diagnosis of fibromyalgia syndrome ( FMS ) according to the American College of Rheumatology criteria . INTERVENTION The participants were r and omly assigned into 2 groups . In group 1 , a Pilates exercise program of 1 hour was given by a certified trainer to 25 participants 3 times a week for 12 weeks . In group 2 , which was design ed as the control group , 25 participants were given a home exercise ( relaxation/stretching ) program . In both groups , pre- ( week 0 ) and posttreatment ( week 12 and week 24 ) evaluation was performed by one of the authors , who was blind to the group allocation . MAIN OUTCOME MEASURES Primary outcome measures were pain ( visual analog scale ) and Fibromyalgia Impact Question naire ( FIQ ) . Exploratory outcome measures were number of tender points , algometric score , chair test , and Nottingham Health Profile . RESULTS Twenty-five Pilates exercise and 24 relaxation/stretching exercise  participants completed the study . In group 1 , significant improvement was observed in both pain and FIQ at week 12 but only in FIQ at 24 weeks . In group 2 , no significant improvement was obtained in pain and FIQ at week 12 and week 24 . Comparison of the 2 groups showed significantly superior improvement in pain and FIQ in group 1 at week 12 but no difference between the 2 groups at week 24 . CONCLUSIONS We suggest Pilates as an effective and safe method for people with FMS . Our study is the first clinical study design ed to investigate the role of the Pilates method in FMS treatment . We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method BACKGROUND AND OBJECTIVE Affect and how it is regulated plays a role in pain perception , maintenance of pain , and its resolution . This r and omized , controlled trial evaluated an innovative affective self-awareness ( ASA ) intervention , which was design ed to reduce pain and improve functioning in individuals with fibromyalgia . PARTICIPANTS AND METHODS Forty-five women with fibromyalgia were r and omized to a  manualized ASA intervention ( n = 24 ) or wait-list control ( n = 21 ) . The intervention began with a one-time physician consultation , followed by 3 weekly , 2-h group sessions based upon a mind-body model of pain . Sessions focused on structured written emotional disclosure and emotional awareness exercises . Outcomes in both conditions were measured by a blinded assessor at baseline , post-intervention , and 6-month follow-up . MEASURES The primary outcome was pain severity ( Brief Pain Inventory ) ; secondary outcomes included tender-point threshold and physical function ( SF-36 Physical Component Summary ) . Intent-to-treat analyses compared groups on outcomes using analysis of covariance and on the proportion of patients achieving ≥30 % and ≥50 % pain reduction at 6 months . RESULTS Adjusting for baseline scores , the intervention group had significantly lower pain severity ( p < 0.001 ) , higher self-reported physical function ( p < 0.001 ) , and higher tender-point threshold ( p = 0.02 ) at 6 months compared to the control group . From baseline to 6 months , 45.8 % of the ASA intervention group had ≥30 % reduction in pain severity , compared to none of the controls ( p < 0.001 ) . CONCLUSIONS The affective self-awareness  intervention improved pain , tenderness , and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control . This study suggests the value of interventions targeting emotional processes in fibromyalgia , although further studies should evaluate the efficacy of this intervention relative to active controls Introduction The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking ( NW ) on functional capacity and pain in fibromyalgia ( FM ) . Methods A total of 67 women with FM were recruited to the study and r and omized either to moderate-to-high intensity Nordic Walking ( n = 34 , age 48 ± 7.8 years ) or to a control group engaging in supervised low-intensity walking ( LIW , n = 33 , age 50 ± 7.6 years ) . Primary outcomes were the six-minute walk test ( 6MWT ) and the Fibromyalgia Impact Question naire Pain scale ( FIQ Pain ) . Secondary outcomes were : exercise heart rate in a submaximal ergometer bicycle test , the FIQ Physical ( activity limitations ) and the FIQ total score . Results A total of 58 patients completed the post-test . Significantly greater improvement in the 6MWT was found in the NW group ( P = 0.009 ) , as compared with the LIW group . No between-group difference was found for the FIQ Pain ( P = 0.626 ) . A significantly larger decrease in exercise heart rate ( P = 0.020 ) and significantly improved scores on the FIQ Physical ( P = 0.027 ) were found in the NW group as compared with the LIW group . No between-group difference was found for the change in the FIQ total . The effect sizes were moderate for the above mentioned outcomes . Conclusions Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise , result ing in improved functional capacity and a decreased level of activity limitations . Pain severity did not change over time during the exercise period . Trial registration Clinical trials.gov identifier NCT00643006 Previous research ers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia ( FM ) . The purpose of this study was to further investigate earlier findings and add a focus on functional mobility . We conducted a parallel-group r and omized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control . Participants met in small groups twice weekly for 90 min over 12 weeks . The primary endpoint was symptom reduction and improvement in self-report physical function , as measured by the Fibromyalgia Impact Question naire ( FIQ ) , from baseline to 12 weeks . Secondary endpoints included pain severity and interference ( Brief Pain Inventory ( BPI ) , sleep ( Pittsburg sleep Inventory ) , self-efficacy , and functional mobility . Of the 101 r and omly assigned subjects ( mean age 54 years , 93 % female ) , those in the Tai chi condition compared with the education condition demonstrated clinical ly and statistically significant improvements in FIQ scores ( 16.5 vs. 3.1 , p = 0.0002 ) , BPI pain severity ( 1.2 vs. 0.4 , p = 0.0008 ) , BPI pain interference ( 2.1 vs. 0.6 , p = 0.0000 ) , sleep ( 2.0 vs. −0.03 , p = 0.0003 ) , and self-efficacy for pain control ( 9.2 vs. −1.5 , p = 0.0001 ) . Functional mobility variables including timed get up and go ( −.9 vs. −.3 , p = 0.0001 ) , static balance ( 7.5 vs. −0.3 , p = 0.0001 ) , and dynamic balance ( 1.6 vs. 0.3 , p = 0.0001 ) were significantly improved with Tai chi compared with education control . No adverse events were noted . Twelve weeks of Tai chi , practice twice weekly , provided worthwhile improvement in common FM symptoms including pain and physical function including mobility .  Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients . ( Clinical Trials.gov Identifier , NCT01311427 Background Self-management programmes ( SMP ) are recommended for patients with fibromyalgia . The purpose of this study was to evaluate effects of a one week multidisciplinary inpatient self-management programme on psychological distress , skills as a consumer of health services , self-efficacy , and functional and symptomatic consequences of fibromyalgia  ( FM ) . Methods A r and omised controlled two-armed , assessor-blinded trial with three-week follow-up to evaluate SMP . Primary outcomes were the General Health Question naire ( GHQ-20 ) and the Effective Musculoskeletal Consumer Scale ( EC-17 ) , while secondary outcomes included the Fibromyalgia Impact Question naire ( FIQ ) and Self-efficacy scales for pain , function and symptoms ( ASES ) . Results 150 patients with FM were r and omised to one week one SMP ( n = 75 ) or to a waiting list control group ( n = 75 ) . Of these , 58 participants in the treatment group and 60 in the control group completed the study . At three weeks ’ follow up there was a significant difference in EC-17 ( 0 - 100 ) in favour of the treatment group ( mean difference 4.26 , 95 CI 0.8 to 7.7 , p = 0.02 ) . There were no differences between the groups for any of the other outcomes . Conclusion This study shows that in patients with FM the SMP had no effect on psychological distress , functional and symptomatic consequences and self-efficacy , except for a small short-term effect on skills and behaviour that are important for managing and participating in health care ( EC-17 ) . Clinical Trials.gov I d : NCT01035125.Trial registration Clinical Trials.gov I d : This study aim ed to examine the effectiveness of a multidisciplinary intervention with aftercare ( MD ) compared to aerobic exercise ( AE ) and usual care ( UC ) in recently diagnosed patients with fibromyalgia ( FM ) . In a Zelen-like design , eligible patients from the outpatient rheumatology clinics of three medical centres in the South of the Netherl and s were consecutively recruited and pre-r and omised to MD ( n = 108 ) , AE ( n = 47 ) or UC ( n = 48 ) .  MD consisted of a 12-week course of sociotherapy , physiotherapy , psychotherapy and creative arts therapy ( three half days per week ) , followed by five aftercare meetings in 9 months . AE was given twice a week in a 12-week course . UC varied but incorporated at least education and lifestyle advice . Primary outcomes were health-related quality of life ( HR-Qol ) , participation and health care utilisation . Secondary outcome was the Fibromyalgia Impact Question naire ( FIQ ) . Total follow-up duration of the study was 21–24 months . As willingness to participate in AE was limited , this group has been analysed but interpretation of the data is considered arguable . Within the MD group , a statistically significantly improved HR-Qol and a statistically significant reduction in number of hours sick leave , number of contacts with general practitioners and number of contacts with medical specialists was found . Moreover , statistically significant improvements were found on the FIQ , which increased after the intervention . However , no statistically significant between-group differences were found at the endpoint of the study . MD seemed to yield positive effects , but firm conclusions with regard to effectiveness can not be formulated due to small between-group differences and limitations of the study OBJECTIVES To assess the efficacy of a 6-week interdisciplinary treatment that combines coordinated psychological , medical , educational , and physiotherapeutic components ( PSYMEPHY ) over time compared to st and ard pharmacologic care . METHODS R and omised controlled trial with follow-up at 6 months for the PSYMEPHY and control groups and 12 months for the PSYMEPHY group . Participants were 153 out patients with FM recruited from a hospital pain management unit . Patients r and omly allocated to the control group ( CG ) received st and ard pharmacologic therapy . The experimental group ( EG ) received an interdisciplinary treatment ( 12 sessions ) . The main outcome was changes in quality of life , and secondary outcomes were pain , physical function , anxiety , depression , use of pain coping strategies , and satisfaction with treatment as measured by the Fibromyalgia Impact Question naire , the Hospital Anxiety and Depression Scale , the Coping with Chronic Pain Question naire , and a question regarding satisfaction with the treatment . RESULTS Six months after the intervention , significant improvements in quality of life ( p=0.04 ) , physical function ( p=0.01 ) , and pain ( p=0.03 ) were seen in the PSYMEPHY group ( n=54 ) compared with controls ( n=56 ) . Patients receiving the intervention reported greater satisfaction with treatment . Twelve months after the intervention , patients in the PSYMEPHY group ( n=58 ) maintained statistically significant improvements in quality of life , physical functioning , pain , and symptoms of anxiety and depression , and were less likely to use maladaptive passive coping strategies compared to baseline . CONCLUSIONS An interdisciplinary treatment for FM was associated with improvements in quality of life , pain , physical function , anxiety and depression , and pain coping strategies up to 12 months after the intervention Objective Alzheimer ’s disease and related dementias ( ADRD ) affect more than five million Americans and their family caregivers . Caregiving creates challenges , may contribute to decreased caregiver health and is associated with $ 9.7 billion of caregiver health care costs . The purpose of this 12 month r and omized clinical trial ( RCT ) was to examine if the Enhancing Physical Activity Intervention ( EPAI ) , a moderate to vigorous physical activity ( MVPA ) treatment group , versus the Caregiver Skill Building Intervention ( CSBI ) control , would have greater : ( 1 ) MVPA adherence ; and ( 2 ) physical function . Methods Caregivers were r and omly assigned to EPAI or CSBI ( N=211 ) .  MVPA was assessed using a self-report measure ; and physical function was objective ly assessed using two measures . Intention-to-treat analyses used descriptive , categorical and generalized estimating equations ( GEE ) , with an exchangeable working correlation matrix and a log link , to examine main effects and interactions in change of MVPA and physical function over time . Results At 12 months , EPAI significantly increased MVPA ( p=<0.001 ) and number of steps ( p= < .01 ) ; maintained stable caregiving hours and use of formal services ; while CSBI increased hours of caregiving ( p=<0.001 ) and used more formal services ( p=<0.02 ) . Qualitative physical function data indicated that approximately 50 % of caregivers had difficulties completing physical function tests . Conclusion The EPAI had a stronger 12 month effect on caregiver MVPA and physical function , as well as maintaining stability of caregiving hours and formal service use ; while CSBI increased caregiving hours and use of formal services . A study limitation included greater EPAI versus CSBI attrition . Future directions are proposed for dementia family caregiver physical activity research & NA ; A mounting body of literature recommends that treatment for fibromyalgia ( FM ) encompass medications , exercise and improvement of coping skills . However , there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping . The aim of this r and omized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping . A sample of 53 female FM patients were r and omized to the 8‐week Yoga of Awareness program ( gentle poses , meditation , breathing exercises , yoga‐based coping instructions , group discussion s ) or to wait‐listed st and ard care . Data were analyzed by intention to treat . At post‐treatment , women assigned to the yoga program showed significantly greater improvements on st and ardized measures of FM symptoms and functioning , including pain , fatigue , and mood , and in pain catastrophizing , acceptance , and other coping strategies . This pilot study provides promising support for the potential benefits of a yoga program for women with FM OBJECTIVES This study aim ed to verify whether techniques of yoga with and without the addition of Tui Na might improve pain and the negative impact of fibromyalgia ( FMS ) on patients ' daily life . DESIGN Forty ( 40 ) FMS women were r and omized into two groups , Relaxing Yoga ( RY ) and Relaxing Yoga plus Touch ( RYT ) , for eight weekly sessions of stretching , breathing , and relaxing yogic techniques . RYT patients were further su bmi tted to manipulative techniques of Tui Na . OUTCOME MEASURE Outcome measures comprised the Fibromyalgia Impact Question naire ( FIQ ) , pain threshold at the 18 FMS tender points , and a verbal graduation of pain assessed before treatment and on the followup . The visual analog scale ( VAS ) for pain was assessed before and after each session and on the follow-up . RESULTS Seventeen ( 17 ) RYT and 16 RY patients completed the study . Both RY and RYT groups showed improvement in the FIQ and VAS scores , which decreased on all sessions . The RYT group showed lower VAS and verbal scores for pain on the eighth session , but this difference was not maintained on the follow-up . Conversely , RY VAS and verbal scores were significantly lower just on the follow-up . CONCLUSIONS These study results showed that yogic techniques are valid therapeutic methods for FMS . Touch addition yielded greater improvement during the treatment . Over time , however , RY patients reported less pain than RYT . These results suggest that a passive therapy may possibly decrease control over FMS symptoms Objectives : To evaluate the feasibility of a r and omized-controlled trial and to obtain estimates of the effects of combined cognitive-behavioral therapy ( CBT ) and milnacipran for the treatment of fibromyalgia . Methods : Fifty-eight patients with fibromyalgia were r and omized to 1 of the 3 treatment arms : ( 1 ) combination therapy ( n=20 ) ; ( 2 ) milnacipran+education ( n=19 ) ; and ( 3 ) placebo+CBT ( n=19 ) . Patients received either milnacipran ( 100 mg/d ) or placebo . Patients also received 8 sessions of phone-delivered CBT or educational instructions , but only from baseline to week 9 . Assessment s were conducted at baseline , week 9 , and 21 . The primary endpoints were baseline to week 21 changes in weekly average pain intensity and physical function ( SF-36 physical function scale ) . Results : Compared with milnacipran , combination therapy demonstrated a moderate effect on improving SF-36 physical function ( SE=9.42 [ 5.48 ] , P=0.09 , effect size=0.60 ) and in reducing weekly average pain intensity ( mean difference [SE]=−1.18 [ 0.62 ] , P=0.07 , effect size=0.67 ) . Compared with milnacipran , CBT had a moderate to large effect in improving SF-36 physical function ( mean difference [SE]=11.0 [ 5.66 ] , P=0.06 , effect size=0.70 ) . Despite the presence of concomitant central ly acting therapies , dropout rate was lower than anticipated ( 15 % at week 21 ) . Importantly , at least 6 out of the 8 phone-based therapy sessions were successfully completed by 89 % of the patients ; and adherence to the treatment protocol s was > 95 % . Conclusions : In this pilot study , a therapeutic approach that combines phone-based CBT and milnacipran was feasible and acceptable . Moreover , the preliminary data supports conducting a fully powered r and omized-controlled trial . Clinical Trial Registration : NCT01038323 OBJECTIVE The objective of this study was to evaluate resistance training ( RES ) and RES combined with chiropractic treatment ( RES-C ) on fibromyalgia ( FM ) impact and functionality in women with FM . DESIGN The design of the study was a r and omized control trial . SETTING Testing and training were completed at the university and chiropractic treatment was completed at chiropractic clinics . PARTICIPANTS Participants ( 48 + /- 9 years ; mean + /- st and ard deviation ) were r and omly assigned to RES ( n = 10 ) or RES-C ( n = 11 ) . INTERVENTION Both groups completed 16 weeks of RES consisting of 10 exercises performed two times per week . RES-C received RES plus chiropractic treatment two times per week . OUTCOME MEASURES Strength was assessed using one repetition maximum for the chest press and leg extension . FM impact was measured using the FM impact question naire , myalgic score , and the number of active tender points . Functionality was assessed using the 10-item Continuous Scale Physical Functional Performance test . Analyses of variance with repeated measures compared groups before and after the intervention . RESULTS Six ( 6 ) participants discontinued the study : 5 from  RES  and 1 from RES-C.  Adherence to training was significantly higher in RES-C ( 92.0 + /- 7.5 % ) than in RES ( 82.8 + /- 7.5 % ) . Both groups increased ( p < or = 0.05 ) upper and lower body strength . There were similar improvements in FM impact in both groups . There were no group interactions for the functionality measures . Both groups improved in the strength domains ; however , only RES-C significantly improved in the pre- to postfunctional domains of flexibility , balance and coordination , and endurance . CONCLUSIONS In women with FM , resistance training improves strength , FM impact , and strength domains of functionality . The addition of chiropractic treatment improved adherence and dropout rates to the resistance training and facilitated greater improvements in the domains of functionality Women diagnosed with fibromyalgia ( N = 72 ) participated in a 10-week r and omized trial to examine the effectiveness of guided imagery on self-efficacy , perceived stress , and selected biobehavioral factors ( FMS symptoms ; immune biomarkers ) . Participants in both guided imagery and usual care control conditions  completed measures and donated 3 cc of blood at baseline , 6- and 10-weeks . A mixed effects linear model to test for differences between groups for all behavioral and biologic variables demonstrated that after 10 weeks of daily intervention use , guided imagery participants reported statistically significant increases in self-efficacy and statistically significant decreases in stress , fatigue , pain , and depression . There were no statistically significant changes in biomarker levels , although total group C-reactive protein was elevated at baseline ( 4.7 mg/L ) , indicating an inflammatory process . Subsequent studies should be undertaken to more fully eluci date the biobehavioral aspects of nonpharmacological intervention effectiveness The purpose of this study was to evaluate the efficacy of a multidisciplinary treatment program in patients severely affected by fibromyalgia . Thirty-four fibromyalgia patients were r and omly divided into two groups . The control group : 17 women who continued their medical treatment and participated in four educational sessions  and the experimental group that included 17 patients who besides the former medical treatment  also underwent a weekly 1-h session program for 8 weeks including massage therapy , ischemic pressure on the 18 tender points , aerobic exercise and thermal therapy . At the beginning of the program , there were no significant differences between the two groups in any of the parameters . At the end of treatment , there was a significant improvement in the experimental group in the following items : vitality , social functioning , grip strength and the 6-min walk test . At 1 month after the end of treatment , the experimental group showed significant differences in overall health perception , social functioning , grip strength and the 6-min walk test . At that time , considering the threshold for clinical efficacy set at an improvement of 30 % or above for the analyzed variables , 25 % of the patients met the requirement for improvement of the following : number of symptoms : Visual Analogic Scale for fatigue , Fibromyalgia Impact Question naire and Beck Anxiety Inventory . In conclusion , patients with severe manifestations of fibromyalgia can obtain improvement with a short-term , low-cost and simple-delivery multidisciplinary program . However , additional studies including higher numbers of patients are needed to confirm the beneficial effect of this treatment program Objectives : Regular exercise is associated with important benefits in patients with fibromyalgia ( FM ) . Unfortunately , long-term maintenance of exercise after a structured program is rare . The present study tested the efficacy of Motivational Interviewing ( MI ) to promote exercise and improve symptoms in patients with FM . Methods : A total of 216 patients with FM were r and omized to 6 MI sessions ( n=107 ) or an equal number of FM self-management lessons ( education control/EC , n=109 ) . Co- primary endpoints were an increase of 30 minutes in moderate-vigorous physical activity and improvement in the Fibromyalgia Impact Question naire (FIQ)-Physical Impairment score , assessed at pretreatment , posttreatment , and 3-month and 6-month follow-up . Secondary outcomes included clinical ly meaningful improvements in FIQ score , pain severity ratings , and a 6-minute walk test . Results : There were no significant treatment group differences in either co- primary endpoint at 6-month follow-up . However , more MI participants than controls exhibited meaningful improvements in FIQ score at 6-month follow-up ( 62.9 % vs. 49.5 % , P=0.06 ) . Compared with EC participants , MI participants also displayed a larger increment in their 6-minute walk test ( 43.9 vs. 24.8 m , P=0.03 ) . In addition , MI was superior to EC in increasing the number of hours of physical activity immediately postintervention and in reducing pain severity both immediately after the intervention and at 3-month follow-up . Conclusions : Despite a lack of benefits on long-term outcome , MI seems to have short-term benefits with respect to self-report physical activity and clinical outcomes . This is the first study in FM that explicitly addresses exercise maintenance as a primary aim . Clinical Trial Registration : NCT00573612 OBJECTIVES ( 1 ) To investigate the effects of a 6-week intervention of guided imagery on pain level , functional status , and self-efficacy in persons with fibromyalgia ( FM ) ; and ( 2 ) to explore the dose-response effect of imagery use on outcomes . DESIGN Longitudinal , prospect i ve , two-group , r and omized , controlled clinical trial . SETTING AND SUBJECTS The sample included 48 persons with FM recruited from physicians ' offices and clinics in the mid-Atlantic region . INTERVENTION Participants  r and omized to Guided Imagery ( GI ) plus Usual Care intervention group received a set of three audiotaped guided imagery scripts and were instructed to use at least one tape daily for 6 weeks and report weekly frequency of use ( dosage ) . Participants assigned to the Usual Care alone group su bmi tted weekly report forms on usual care . MEASURES All participants completed the Short-Form McGill Pain Question naire ( SF-MPQ ) , Arthritis Self- Efficacy Scale ( ASES ) , and Fibromyalgia Impact Question naire ( FIQ ) , at baseline , 6 , and 10 weeks , and su bmi tted frequency of use report forms . RESULTS FIQ scores decreased over time in the GI group compared to the Usual Care group ( p = 0.03 ) . Ratings of self-efficacy for managing pain ( p = 0.03 ) and other symptoms of FM also increased significantly over time ( p = < 0.01 ) in the GI group compared to the Usual Care group . Pain as measured by the SF-MPQ did not change over time or by group . Imagery dosage was not significant . CONCLUSIONS This study demonstrated the effectiveness of guided imagery in improving functional status and sense of self-efficacy for managing pain and other symptoms of FM . However , participants ' reports of pain did not change . Further studies investigating the effects of mind-body interventions as adjunctive self-care modalities are warranted in the fibromyalgia patient population OBJECTIVE To assess the impact of a long-term exercise programme vs usual care on perceived health status , functional capacity and depression in patients with fibromyalgia . DESIGN R and omized controlled trial . SUBJECTS Forty-two women with fibromyalgia were allocated r and omly to 1 of 2 groups : an experimental group that carried out aerobic , strength and flexibility exercises for 24 weeks and a usual care control group . METHODS Health status and functional capacity were evaluated using the Fibromyalgia Impact Question naire and the Short Form Health Survey 36 . Depression was evaluated with the Beck Depression Inventory . RESULTS Significant improvements were observed in health status and functional capacity for the exercise group over the control group . The magnitude of the effect size of these improvements , expressed as Cohen 's d , was medium . The effect size ( 95 % confidence interval ) for the Fibromyalgia Impact Question naire was 0.58 ( -14.12 , -2.35 ) , for the Short Form Health Survey 36 . global score 0.54 ( 1.28 , 14.52 ) , and in the mental health domain of the Short Form Health Survey 36 . 0.51 ( 1.20 , 16.26 ) . There was a large effect size in vitality . All the aforementioned improvements can be considered as clinical ly important changes . CONCLUSION Results confirm that a long-term combination of aerobic exercise , strengthening and flexibility improves psychological health status and health-related quality of life in patients with fibromyalgia OBJECTIVES To analyse the effect of a 24-week physical training programme in water and on l and on women with fibromyalgia . METHODS A controlled study was conducted from December 2009 to May 2010 . Seventy-two women with fibromyalgia ( age : 51.79±7.87 years ) were assigned to an exercise group ( 3 sessions/week , 2 sessions in water , 1 session on l and ) ( n=42 ) and to a control group ( n=30 ) . The variables analysed were : number of tender points , visual analogue scale ( VAS ) of pain , algometer score , functional capacity ( leg strength , h and -grip dynamometry , flexibility , agility , balance , aerobic endurance , heart response ) , body composition ( body mass index , fat mass index , skeletal muscle mass index and percentage of body fat ) and psychological variables ( Fibromyalgia Impact Question naire [ FIQ ] and Short Form Health Survey 36 [ SF-36 ] ) . RESULTS The exercise group improved in the algometer score ( p<0.001 ) , positive tender points ( p=0.005 ) , VAS ( p<0.001 ) and FIQ ( p<0.001 ) . Improvements were also detected in functional capacity ( leg strength , p=0.001 ; h and -grip dynamometry , p=0.001 ; flexibility , p<0.001 ; balance , p=0.006 ; 6-minute walk test , p<0.001 ; mean heart rate , p=0.031 ; maximum heart rate , p<0.001 and VO2 max , p<0.001 ) . There was a decrease in the percentage of body fat ( p=0.040 ) . There was also an improvement in the subscales of the SF-36 ; vitality ( p=0.004 ) , mental health ( p=0.001 ) social role functioning ( p=0.020 ) and general health functioning ( p=0.002 ) . CONCLUSIONS The findings of this study show that a 24-week physical training programme ( 3 sessions/week , of which 2 sessions are in water and 1 session is on l and ) reduces pain and disease impact and improves functional capacity in women with fibromyalgia Summary Strengthening and aerobic exercise had equivalent effects on reducing pain severity in patients with fibromyalgia .  Abstract Strength training and aerobic exercise have beneficial effects on pain in adults with fibromyalgia . However , the equivalence of strengthening and aerobic exercise has not been reported . The primary aim of this r and omized equivalence trial involving patients with fibromyalgia admitted to an interdisciplinary pain treatment program was to test the hypothesis that strengthening ( n = 36 ) and aerobic ( n = 36 ) exercise have equivalent effects ( 95 % confidence interval within an equivalence margin ±8 ) on pain , as measured by the pain severity subscale of the Multidimensional Pain Inventory . Secondary aims included determining the effects of strengthening and aerobic exercise  on peak Vo2 uptake , leg strength , and pressure pain thresholds . In an intent‐to‐treat analysis , the mean ( ± st and ard deviation ) pain severity scores for the strength and aerobic groups at study completion were 34.4 ± 11.5 and 37.6 ± 11.9 , respectively . The group difference was −3.2 ( 95 % confidence interval , −8.7 to 2.3 ) , which was within the equivalence margin of Δ8 . Significant improvements in pain severity ( P < .001 ) , peak Vo2 ( P < .001 ) , strength ( P < .001 ) , and pain thresholds ( P < .001 ) were observed from baseline to week 3 in the intent‐to‐treat analysis ; however , patients in the aerobic group ( mean change 2.0 ± 2.6 mL/kg/min ) experienced greater gains ( P < .013 ) in peak Vo2 compared to the strength group ( mean change 0.4 ± 2.6 mL/kg/min ) . Knowledge of the equivalence and physiological effects of exercise have important clinical implication s that could allow practitioners to target exercise recommendations on the basis of comorbid medical conditions or patient preference for a particular type of exercise . This study found that strength and aerobic exercise had equivalent effects on reducing pain severity among patients with fibromyalgia OBJECTIVE Multidisciplinary treatments ( MTs ) are usually recommended for reducing fibromyalgia ( FM ) symptoms and include physical exercise , drug management , education , and cognitive behavior therapy ( CBT ) . However , there is no evidence that CBT adds efficacy to the other therapeutic components . This r and omized controlled trial analyzed the response of FM patients to two MTs , with and without CBT , according to the presence of concurrent symptoms . METHODS Eighty-three women with FM were r and omly assigned to MT or combined MT and CBT . The MT included medical intervention , physical training , education , and discussion of the syndrome . The CBT focused on coping with stress , modifying lifestyles , and changing pain behaviors . Demographic and clinical data , information regarding tender points , and question naire responses about functional capability [ Fibromyalgia Impact Question naire ( FIQ ) ] , health status [ 36-item Short Form Health Survey ( SF-36 ) ] , and mental health [ Symptom Checklist-90-Revised ( SCL-90-R ) ] were obtained at the beginning , at the end of the 15-week treatment , and at 6-month follow-up . Subgroups are identified in relation to treatment response . RESULTS Sixty-six women ( 80 % ) completed treatment . Although the variance of the total sample had changed at posttreatment ( F=2.67 , P=.031 ) , there was no significant effect for the TimexTreatment interaction ( F=1.65 , P=.16 ) . Univariate tests detected a significant fall in the FIQ score . The subgroup of patients with fatigue showed a better response with MT+CBT than with MT . At 6-month follow-up , the statistical differences had been maintained . Intention-to-treat analysis ratified these results . CONCLUSIONS MT improves functional capability and reduces symptom impact . CBT increases mildly the effect of MT in patients with fatigue Background : In a 12-week r and omized controlled trial of the effects of lifestyle physical activity ( LPA ) on symptoms and function among adults with fibromyalgia , we found that  LPA participants increased their average daily step count by 54 % , improved their self-reported functioning by 18 % , and reduced their pain by 35 % . Objectives : The objective of the study was to evaluate the intermediate ( 6 months ) and long-term ( 12 months ) effects of the LPA intervention on outcomes . Methods : Participants completed follow-up assessment s of physical activity , pain , fibromyalgia-related function , fatigue , depression , number of tender points , 6-minute walk test , and perceived improvement at 6 and 12 months after intervention . Results : Of the 73 participants who completed the 12-week trial , 53 ( 73 % ) completed both the 6- and 12-month follow-up . Although the LPA participants reported greater perceived improvement at each follow-up , they did not differ from controls on pain , physical activity , tenderness , fatigue , depression , or the 6-minute walk test . Self-reported functioning declined markedly at follow-up for the LPA participants . Conclusions : Although participants reported greater perceived improvement at each assessment , the beneficial effects of LPA on physical activity , function , and pain found after the 12-week intervention were not sustained over time . This recidivism is seen in studies of activity and exercise in nearly any condition , and innovative methods that may prevent this are a focus of future studies Objective : Written expression of traumatic experiences , an intervention found to have health benefits in rheumatoid arthritis , asthma , and breast cancer , was tested in a r and omized , controlled trial with female fibromyalgia patients . It was hypothesized that relative to controls , patients engaging in the writing intervention would experience improved status on psychological well-being and physical health variables . Methods : Patients ( N = 92 ) were r and omized into a trauma writing group , a control writing group , or usual care control group .  The two writing groups wrote in the laboratory for 20 minutes on 3 days at 1-week intervals . Psychological well-being , pain , and fatigue were the primary outcome variables . Assessment s were made at pretreatment , posttreatment , 4-month follow-up , and 10-month follow-up . Results : The trauma writing group experienced significant reductions in pain ( effect size [ ES ] = 0.49 ) and fatigue ( ES = 0.62 ) and better psychological well-being ( ES = 0.47 ) at the 4-month follow-up relative to the control groups . Benefits were not maintained at the 10-month follow-up . Conclusion : Fibromyalgia patients experienced short-term benefits in psychological and health variables through emotional expression of personal traumatic experiences . ED = written emotional disclosure ; RA = rheumatoid arthritis ; QOL = Quality of Life Scale ; STAI-S = state version , State-Trait Anxiety Inventory ; BDI = Beck Depression Inventory ; MOS = Medical Outcome Study ; CLINHAQ = Clinical Health Assessment Question naire ; FIQ = Fibromyalgia Impact Question naire ; VAS = visual analogue scale ; NW = neutral writing group ; UC = usual-care control group ; ANOVA = analysis of variance ; ES = effect size Background Patients with fibromyalgia ( FM ) experience pain as well as deficits in positive affect and social relations that are not explicitly addressed in most behavioral treatments . Purpose The purpose of this study is to compare the effects of a 12-module online intervention targeting socioemotional regulation via mindful awareness/acceptance ( MSER ) with those of an attention-control treatment , healthy lifestyle tips ( HT ) . Methods Seventy-nine FM patients were r and omly assigned to MSER or HT , with outcomes assessed via online diary reports of pain , coping efficacy , affect , and social relations . Multilevel analyses revealed greater improvements in social functioning , positive affect , and coping efficacy for pain and stress ( all ps < .05 ) in MSER versus HT across the 6-week trial . Conclusions FM patients experience increases in self-efficacy for coping with pain and positive engagement in relationships , marginal increases in positive affect , and decreases in relationship stress from an automated online intervention that targets socioemotional regulation skills . Findings highlight the potential utility of widely accessible , low-cost intervention methods for fibromyalgia ( Clinical trials.gov number NCT01748786 )
target: Strong evidence was found for interventions categorized for this review as  cognitive – behavioral interventions ; relaxation and stress management ; emotional disclosure ; physical activity ;  and  multidisciplinary interventions for improving daily living , pain , depressive symptoms , and fatigue .
  There was limited to no evidence for self-management , and few interventions result ed in better sleep .
  Although the evidence supports interventions within the scope of occupational therapy practice for people with fibromyalgia , few interventions were occupation based
background: This systematic review addresses the effectiveness of occupational therapy – related interventions for adults with fibromyalgia .