title: Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome The prevalence and characteristics of fibromyalgia in the general population. Aerobic fitness effects in fibromyalgia. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. An exercise program in the treatment of fibromyalgia. A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia. Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia. Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients The effects of exercise training on mental well-being in the normal population: a controlled trial. High or low intensity aerobic fitness training in fibromyalgia: does it matter? Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. A comparative evaluation of a fibromyalgia rehabilitation program. Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia. A randomized, double-blind clinical trial. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebo-controlled study. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. An observer-blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Maintenance of exercise in women with fibromyalgia.
abstract: Abstract Objective : To assess the efficacy of an educational intervention explaining symptoms to encourage grade d exercise in patients with chronic fatigue syndrome . Design : R and omised controlled trial . Setting : Chronic fatigue clinic and infectious diseases outpatient clinic . Subjects : 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome . Interventions : Patients r and omised to the control group received st and ardised medical care .  Patients r and omised to intervention received two individual treatment sessions and two telephone follow up calls , supported by a comprehensive educational pack , describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based grade d exercise . The minimum intervention group had no further treatment , but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months . Main outcome measure : A score of 25 or an increase of 10 on the SF-36 physical functioning subscale ( range 10 to 30 ) 12 months after r and omisation . Results : 21 patients dropped out , mainly from the intervention groups . Intention to treat analysis showed 79 ( 69 % ) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two ( 6 % ) of controls , who received st and ardised medical care ( P<0.0001 ) . Similar improvements were observed in fatigue , sleep , disability , and mood . No significant differences were found between the three intervention groups . Conclusions : Treatment incorporating evidence based physiological explanations for symptoms  was effective in encouraging self managed grade d exercise . This result ed in substantial improvement compared with st and ardised medical care OBJECTIVE To determine the prevalence and characteristics of fibromyalgia in the general population . METHODS A r and om sample of 3,006 persons in Wichita , KS , were characterized according to the presence of no pain , non-widespread pain , and widespread pain . A sub sample of 391 persons , including 193 with widespread pain , were examined and interviewed in detail . RESULTS The prevalence of fibromyalgia was 2.0 % ( 95 % confidence interval [ 95 % CI ] 1.4 , 2.7 ) for both sexes , 3.4 % ( 95 % CI 2.3 , 4.6 ) for women , and 0.5 % ( 95 % CI 0.0 , 1.0 ) for men . The prevalence of the syndrome increased with age , with highest values attained between 60 and 79 years ( > 7.0 % in women ) . Demographic , psychological , dolorimetry , and symptom factors were associated with fibromyalgia . CONCLUSION Fibromyalgia is common in the population , and occurs often in older persons . Characteristic features of fibromyalgia -- pain threshold and symptoms -- are similar in community and clinic population s , but overall severity , pain , and functional disability are more severe in the clinic population OBJECTIVE To compare 2 exercise modalities , aerobic fitness training and stretching exercises , in patients with fibromyalgia ( FM ) in relation to function , pain , quality of life , depression , and anxiety , and to correlate the cardiorespiratory fitness gain with symptom improvement . METHODS Seventy-six women with FM between 18 and 60 years old were r and omized to either an aerobic program or stretching program , for 20 weeks . They were evaluated at the beginning of the program and after 10 and 20 weeks in relation to the improvement of aerobic fitness , flexibility , function , Fibromyalgia Impact Question naire ( FIQ ) , Short-form Health Survey ( SF-36 ) , and depression and anxiety levels . Ventilatory anaerobic threshold ( VT ) and maximum oxygen uptake ( VO2max ) were determined by expired gas analyses . RESULTS Aerobic exercise was superior to stretching in relation to VO2 max , VT , function , depression , pain , and the emotional aspects and mental health domains of SF-36 . Patients in the stretching group showed no improvement in depression , " role emotional , " and " mental health . " No association was noted between improvement in aerobic fitness as measured by VT and the improvement of pain , function , or scores in FIQ and SF-36 . CONCLUSION Our results confirm that aerobic exercise is beneficial to patients with FM , but the cardiorespiratory fitness gain is not related to improvement of FM symptoms OBJECTIVE Fibromyalgia syndrome ( FMS ) is characterized by widespread musculoskeletal pain and lowered pain threshold . Other prominent symptoms include disordered sleep and fatigue . FMS affects an estimated 2 % of the population , predominantly women . This trial was design ed to evaluate the efficacy and safety of pregabalin , a novel alpha(2)-delta lig and , for treatment of symptoms associated with FMS . METHODS This multicenter , double-blind , 8-week , r and omized clinical trial compared the effects of placebo with those of 150 , 300 , and 450 mg/day pregabalin on pain , sleep , fatigue , and health-related quality of life in 529 patients with FMS . The primary outcome variable was the comparison of end point mean pain scores , derived from daily diary ratings of pain intensity , between each of the pregabalin treatment groups and the placebo group . RESULTS Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo ( -0.93 on a 0 - 10 scale ) ( P < /= 0.001 ) , and significantly more patients in this group had > /=50 % improvement in pain at the end point ( 29 % , versus 13 % in the placebo group ; P = 0.003 ) . Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality , fatigue , and global measures of change .  Pregabalin at 450 mg/day improved several domains of health-related quality of life . Dizziness and somnolence were the most frequent adverse events . Rates of discontinuation due to adverse events were similar across all 4 treatment groups . CONCLUSION Pregabalin at 450 mg/day was efficacious for the treatment of FMS , reducing symptoms of pain , disturbed sleep , and fatigue compared with placebo . Pregabalin was well tolerated and improved global measures and health-related quality of life OBJECTIVE To compare responses to trigger point ( TrP ) injection between patients having both myofascial pain syndrome ( MPS ) caused by active TrPs and fibromyalgia syndrome ( FMS ) and patients with MPS due to TrPs but without FMS . DESIGN Prospect i ve design blinded measurement , before- after trial . SETTING A pain control medical clinic . PATIENTS Group 1 : MPS + FMS ; Group 2 : MPS only . All patients ( 9 in each group ) had active TrPs in the upper trapezius muscle . INTERVENTION Myofascial TrP injection with 0.5 % xylocaine . MAIN OUTCOME MEASURES Subjective pain intensity ( PI ) , pain threshold ( PT ) , and range of motion ( ROM ) were assessed before , immediately after , and 2 weeks after TrP injection . RESULTS In a comparison of preinjection measures to immediate postinjection measures , only ROM was significantly improved ( p < .05 ) in Group 1 patients ; all three parameters were significantly improved ( p < .05 ) in the Group 2 patients who had only MPS . Two weeks after injection , both groups showed significant improvement ( p < .05 ) in all three measured parameters as compared to preinjection measurements . In a comparison of the two groups , the immediate effectiveness of  TrP injection  was significantly less ( p < .05 ) in Group 1 than in Group 2 for all three parameters . Two weeks after injection , the degree of improvement in PT or ROM ( but not PI ) was not significantly different between two groups . Postinjection soreness ( different from myofascial pain ) was more severe , developed sooner , and lasted longer in Group 1 than in Group 2 . CONCLUSION Trigger point injection is a valuable procedure for pain relief for patients in both group . Patients with FMS are likely to experience significant but delayed and attenuated pain relief following injection of their active TrPs compared to myofascial pain patients with similar TrPs but without FMS . Also , FMS patients are likely to experience significantly more postinjection soreness for a longer period of time OBJECTIVE To assess the utility of an exercise program , which included aerobic , flexibility and strengthening elements , in the treatment of fibromyalgia ( FM ) . FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching . It has been suggested that aerobic exercise is helpful in its treatment . METHODS We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities . Measurements performed on each patient at the pre and post study assessment included the number of tender points ( TP ) , total myalgic scores ( TM ) , aerobic fitness ( AF ) , flexibility and isokinetic strength . After initial evaluation patients were r and omly assigned to either an exercise or a relaxation group . Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation . All patients data were stored in a computerized data base and statistical analysis was performed on all pre and post study assessment s. RESULTS Thirty-eight patients ( 18 exercise and 20 relaxation ) completed the study . Analysis of our data showed no significant difference between the groups in their pre study assessment . Post study assessment s , however , showed a significant improvement between the exercise and relaxation groups in TP ( p < 0.05 ) , TM ( p < 0.05 ) , and AF ( p < 0.05 ) . Similar improvements were also found when the pre and post study assessment of the exercise group were compared . CONCLUSION Exercise is helpful in the management of FM in the short term . It also shows that FM patients can undertake an exercise program which includes aerobic , flexibility , and strength training exercises without adverse effects . The long term utility of this type of exercise requires further evaluation OBJECTIVE To determine the efficacy of a 12-week individualized home-based exercise programme on physical functioning , pain severity and psychological distress for women with fibromyalgia ( FM ) . METHODS Seventy-nine women with a primary diagnosis of FM were r and omized to a 12-week individualized home-based moderate-intensity exercise programme or to a usual care control group . Outcomes were functional capacity ( Fibromyalgia Impact Question naire ) , pain severity and psychological distress . Outcomes were measured at study entry , at the end of the 12-week intervention , and at 3 and 9 months following completion of the intervention . RESULTS On the basis of intention-to-treat analyses , a significant improvement in functional capacity at 3 and 9 months following treatment for participants in the exercise group who were more functionally disabled at study entry was observed . At both 3 and 9 months post-treatment , the mean estimated benefit of the intervention was more than 10 points [ -12.3 ( 95 % CI , -21.9 to -2.8 ) ; -10.8 ( 95 % CI , -21.5 to -0.2 ) ] . Compared with the control group , statistically significant improvements in upper body pain were evident in the exercise group at post-treatment . These between-group differences in upper body pain were maintained at 3 and 9 months post-treatment . No statistically significant group differences on lower body pain and psychological distress were found . CONCLUSIONS Home-based exercise , a relatively low-cost treatment modality , has the potential to improve important health outcomes in FM OBJECTIVE To measure mood and physical function of individuals with fibromyalgia , 6 and 12 months following 23 weeks of supervised aerobic exercise . METHODS This is a followup report of individuals who were previously enrolled in 23 weeks of l and -based and water-based aerobic exercise classes .  Outcomes included the 6-minute walk test , Beck Depression Inventory ( BDI ) , State-Trait Anxiety Inventory , Arthritis Self-Efficacy Scale ( ASES ) , Fibromyalgia Impact Question naire ( FIQ ) , tender point count , patient global assessment score , and exercise compliance . Outcomes were measured at the start and end of the exercise classes and 6 and 12 months later . RESULTS Analyses were conducted on 29 ( intent-to-treat ) or 18 ( efficacy ) subjects .  Six-minute walk distances and BDI total scores were improved at followup ( all analyses ) . BDI cognitive/affective scores were improved at the end of 23 weeks of exercise ( both analyses ) and at the 12-month followup ( efficacy analysis only ) . BDI somatic scores were improved at 6-month ( both analyses ) and 12-month followup ( intent-to-treat only ) . FIQ and ASES function were improved at all followup points . ASES pain was improved in efficacy analyses only ( all followup points ) . Tender points were unchanged after 23 weeks of exercise and at followup . Exercise duration at followup ( total minutes of aerobic plus anaerobic exercise in the preceding week ) was related to gains in physical function ( 6- and 12-month followup ) and mood ( 6-month followup ) . CONCLUSION Exercise can improve physical function , mood , symptom severity , and aspects of self efficacy for at least 12 months . Exercising at followup was related to improvements in physical function and perhaps mood OBJECTIVE To estimate the point prevalence of fibromyalgia syndrome ( FM )  among noninstitutionalized Canadian adults ; and to assess the effect of demographic variables on the odds of having FM . METHODS A screening question naire was administered via telephone to a r and om community sample of 3395 noninstitutionalized adults residing in London , Ontario . Individuals screening positive were invited to be examined by a rheumatologist to confirm or exclude FM using the 1990 American College of Rheumatology classification criteria . RESULTS One hundred confirmed cases of FM were identified , of whom 86 were women . Mean age among FM cases was 49.2 years among women , 39.3 years among men ( p < 0.02 ) . FM affects an estimated 4.9 % ( 95 % CI 4.7 % , 5.1 % ) of adult women and 1.6 % ( 1.3 % , 1.9 % ) of adult men in London , for a female to male ratio of roughly 3 to one . In women , prevalence rises steadily with age from < 1 % in women aged 18 - 30 to almost 8 % in women 55 - 64 . Thereafter , it declines . The peak prevalence in men also appears to be in middle age ( 2.5 % ; 1.1 % , 5.7 % ) . FM affects 3.3 % ( 3.2 % , 3.4 % ) of noninstitutionalized adults in London . Female sex , middle age , less education , lower household income , being divorced , and being disabled are associated with increased odds of having FM . CONCLUSION FM is a common musculoskeletal disorder among Canadian adults , especially among women and persons of lower socioeconomic status BACKGROUND Chronic fatigue syndrome ( CFS ) , fibromyalgia ( FM ) , and multiple chemical sensitivities ( MCS ) are conditions associated with fatigue and a variety of other symptoms that appear to share many clinical and demographic features . Our objectives were to describe the similarities and differences among patients with CFS , FM , and MCS . Additional objectives were to determine how frequently patients with MCS and FM met the criteria for CFS and if they differed in their health locus of control . METHODS  Demographic , clinical , and psychosocial measures were prospect ively collected in 90 patients , 30 each with CFS , FM , and MCS . Patients were recruited from a university-based referral clinic devoted to the evaluation and treatment of chronic fatigue and three private practice s. Variables included demographic features , symptoms characteristic of each condition , psychological complaints , a measure of health locus of control , and information on health care use .  RESULTS Overall , the three patient groups were remarkably similar in demographic characteristics and the presence of specific symptoms . Patients with CFS and FM frequently reported symptoms compatible with MCS .  Likewise , 70 % of patients with FM and 30 % of those with MCS met the criteria for CFS . Health care use was substantial among patients with CFS , FM , and MCS , with an average of 22.1 , 39.7 , and 23.3 visits , respectively , to a medical provider during the prior year . Health locus of control did not differ among the three population s. CONCLUSIONS In general , demographic and clinical factors and health locus of control do not clearly distinguish patients with CFS , FM , and MCS . Symptoms typical of each disorder are prevalent in the other two conditions OBJECTIVE To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia . METHODS Forty-one subjects were r and omly assigned to the program or served as waiting list controls . Program outcome was assessed with a 6-minute walk test , the Fibromyalgia Impact Question naire , a Self-Efficacy Scale , and a " knowledge " question naire ( based on information provided during the educational sessions ) . Waiting list control subjects subsequently completed the program . Program outcome was reassessed 3 or 6 months post-program . RESULTS The program produced significant improvements in 6-minute walk distance , well-being , fatigue , self-efficacy ( for controlling pain and other symptoms ) , and knowledge . At followup , immediate gains in walk distance , well-being , and self-efficacy were maintained , but gains in fatigue and knowledge were lost . CONCLUSION Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia . The benefits of our program may be due to exercise or education since both interventions were given Forty-two patients with primary fibromyalgia were r and omized into a 20-week program consisting of either cardiovascular fitness ( CVR ) training or simple flexibility exercises ( FLEX ) that did not lead to enhanced cardiovascular fitness . Patients were supervised by the same medical fitness instructors . Patients in neither group had contact with members of the other group , and were blinded as to the exercise taught to the alternative group . Groups met for 60 minutes 3 times each week . The compliance rate was 90 % . Thirty-eight patients completed the study ( 18 with CVR training and 20 with FLEX ) . Blind assessment s ( st and ardized in preliminary trials to achieve acceptable inter-rater agreement ) were performed by the same 2 examiners . After 20 weeks , patients receiving CVR training showed significantly improved cardiovascular fitness scores compared with those receiving FLEX training ( t[35 ] = -4.22 , P less than 0.003 ) . Logistic regression analysis showed clinical ly and statistically significant improvements in pain threshold scores , which were measured directly over fibrositic tender points , in patients undergoing CVR ( t[35 ] = 2.21 , P less than 0.04 ) . There was also a trend toward improvement in pain scores ( visual analog scale ) in the CVR group , but this did not reach statistical significance . There was no improvement in the percentage of body area affected by fibrositic symptoms or the number of nights per week or hours per night of disturbed sleep ( self-report inventories ) . However , compared with the FLEX group , the CVR-trained patients improved significantly in both patient and physician global assessment scores . ( ABSTRACT TRUNCATED AT 250 WORDS & NA ; Central mechanisms related to referred muscle pain and temporal summation of muscular nociceptive activity are facilitated in fibromyalgia syndrome ( FMS ) patients . The present study assessed the effects of an NMDA‐antagonist ( ketamine ) on these central mechanisms . FMS patients received either i.v . placebo or ketamine ( 0.3 mg/kg , Ketalar ® ) given over 30 min on two separate occasions . Habitual pain intensity was assessed on a visual analogue scale ( VAS ) . Initially , 29 FMS patients received ketamine or isotonic saline to determine which patients were ketamine responders ( > 50 % decrease in pain intensity at rest by active drug on two consecutive VAS assessment s ) . Fifteen out of 17 ketamine‐responders were included in the second part of the study . Before and after ketamine or placebo , experimental local and referred pain was induced by intramuscular ( i.m . ) infusion of hypertonic saline ( 0.7 ml , 5 % ) into the tibialis anterior ( TA ) muscle . The saline‐induced pain intensity was assessed on an electronic VAS , and the distribution of pain drawn by the subject . In addition , the pain threshold ( PT ) to i.m . electrical stimulation was determined for single stimulus and five repeated ( 2 Hz , temporal summation ) stimuli . The pressure PT of the TA muscle was determined , and the pressure PT and pressure pain tolerance threshold were determined at three bilaterally located tenderpoints ( knee , epicondyle , and mid upper trapezius ) . VAS scores of pain at rest were progressively reduced during ketamine infusion compared with placebo infusion . Pain intensity ( area under the VAS curve ) to the post‐drug infusion of hypertonic saline was reduced by ketamine ( −18.4±0.3 % of pre‐drug VAS area ) compared with placebo ( 29.9±18.8 % , P<0.02 ) . Local and referred pain areas were reduced by ketamine ( −12.0±14.6 % of pre‐drug pain areas ) compared with placebo ( 126.3±83.2 % , P<0.03 ) . Ketamine had no significant effect on the PT to single i.m . electrical stimulation . However , the span between the PT to single and repeated i.m . stimuli was significantly decreased by the ketamine ( −42.3±15.0 % of pre‐drug PT ) compared with placebo ( 50.5±49.2 % , P<0.03 ) indicating a predominant effect on temporal summation . Mean pressure pain tolerance from the three paired tenderpoints was increased by ketamine ( 16.6±6.2 % of pre‐drug thresholds ) compared with placebo ( −2.3±4.9 % , P<0.009 ) . The pressure PT at the TA muscle was increased after ketamine ( 42.4±9.2 % of pre‐drug PT ) compared with placebo ( 7.0±6.6 % , P<0.011 ) . The present study showed that mechanisms involved in referred pain , temporal summation , muscular hyperalgesia , and muscle pain at rest were attenuated by the NMDA‐antagonist in FMS patients . It suggested a link between central hyperexcitability and the mechanisms for facilitated referred pain and temporal summation in a sub‐group of the fibromyalgia syndrome patients . Whether this is specific for FMS patients or a general phenomena in painful musculoskeletal disorders is not known This study was design ed to compare the effects of two aerobic training programmes of differing intensities on mood and mental well-being with those of a credible attention-placebo condition . One hundred and nine sedentary adult volunteers from the local population were assigned to four conditions : high intensity aerobic training , moderate intensity aerobic training , attention-placebo and waiting list . Training was carried out over a 10 week period . Subjects were assessed before and after training with psychological measures and the 12 min walk-run test , and follow-up evaluations were undertaken after 3 months . Ninety-four subjects began the programme and the adherence rate averaged 80 % , with no significant differences in number of drop-outs between conditions . Appropriate changes in estimated maximum oxygen consumption were observed in the three active conditions with the 12 min walk-run test . Psychological benefits were seen with the moderate exercise condition but not in the high exercise or attention-placebo conditions . These effects were manifest immediately after training on measures of tension/anxiety and confusion , and at follow-up on measures of perceived coping ability . The mechanisms underlying this pattern of results are discussed and the relative importance for health of vigorous activity and physical fitness is considered OBJECTIVE To determine the efficacy of training in fibromyalgia ( FM ) , we compared the effects of high intensity fitness training ( HIF ) and low intensity fitness training ( LIF ) . METHODS Thirty-seven female patients with FM were r and omly allocated to either a HIF group ( n = 19 ) or a LIF group ( n = 18 ) . Four patients ( 1 HIF group , 3 LIF group ) refused to participate after r and omization but before the start of the intervention . They were excluded from the analysis . Assessment s were performed at baseline and after 20 weeks of HIF or LIF . The primary outcome was patient 's global assessment [ on 100 mm visual analog scale ( VAS ) ] . Secondary endpoints were pain , number of tender points , total myalgic score , physical fitness , health status , and psychological distress . RESULTS One patient in the HIF group ( n = 18 ) and 2 in the LIF group ( n = 15 ) stopped training sessions during the course of the study . Nine of 18 patients in the HIF group compared to 8 of 15 patients in the LIF group achieved a participation rate of 67 % or more . Most important reasons for nonadherence were postexercise pain and fatigue , time consumption , and stress . The VAS for global well being improved slightly from 64 to 56 mm in the HIF group , and did not change in the LIF group ( 58 to 61 mm ) ( p = 0.07 ) . The Wmax ( physical fitness ) changed modestly from 110 to 123 watt in the HIF group , and from 97 to 103 watt in the LIF group ( p = 0.3 ) . VAS for pain increased from 53 to 64 mm in the HIF group and from 52 to 54 mm in the LIF group . The large st and ard deviations around mean change in global assessment s , number of tender points , total myalgic score , and psychological distress ( by SCL-90 ) severely influenced the power to detect within- and between-group differences . Analysis limited to those patients who accomplished a high attendance rate ( > 67 % ) showed similar results . CONCLUSION High intensity physical fitness training compared to low intensity physical fitness training leads to only modest improvements in physical fitness and general well being in patients with FM , and does not positively affect psychological status and general health To determine and compare short- and long-term effects of aerobic exercise ( AE ) , stress management treatment ( SMT ) , and treatment-as-usual ( TAU ) in fibromyalgia , 60 patients were r and omized to 14 weeks of treatment by either AE , SMT or TAU . Outcome measures at baseline , midway through treatment , at treatment completion , and at 4 year follow up included a patient made drawing of pain distribution , dolorimetry of tender points , ergometer cycle test , global subjective improvement , and VAS registration s of : pain , disturbed sleep , lack of energy , and depression . Both AE and SMT showed positive short-term effects .  AE was the overall most effective treatment , despite being subject to the most sceptical patient attitude prior to the study . At follow up , there were no obvious group differences in symptom severity , which for AE seemed to be due to a considerable compliance problem UNLABELLED Fibromyalgia ( FM ) , a rheumatological disorder of unknown origin , is characterized by both physical and psychological symptoms . Although inconclusive results have been reported for most treatment modalities , exercise appears to have universal support for decreasing the myriad of symptoms associated with FM . Weaknesses in the literature , however , prevent conclusive statements regarding exercise prescription and concomitant impact on FM symptomology . PURPOSE The current pilot study attempted to examine the effect of a 24-wk walking program at predetermined intensities on FM . METHODS Initial design was a r and omized control trial with  high- and low-intensity exercise groups  , and a control group . Subsequent nonr and omized control trials were based on actual exercise behavior . RESULTS No differences between initial groups were identified . By collapsing groups , heart rate ( HR ) decreased ( P < 0.05 ) weeks 0 - 12 . Functional impairments were reduced 54 % weeks 0 - 24 , with exercise having a large impact ( omega2 = 0.30 ) on this decrease . By reassigning groups , impact of FM on current health status decreased in the low-intensity group ( P < 0.05 ) and increased in the high-intensity group ( P < 0.02 ) weeks 0 - 24 . Omega squared indicated strong influence of exercise on pain ( omega2 = 0.51 ) , with greater pain in the high-intensity group . CONCLUSIONS A larger number of subjects and direct supervision of the training program to increase compliance is necessary to clarify the effects of a walking program on the manifestations of FM . Results indicate that intensity of the walking program is an important consideration . Individuals with FM can adhere to low-intensity walking programs two to three times per week , possibly reducing FM impact on daily activities OBJECTIVE To compare an evidence -based clinical fibromyalgia program , referred to as Fibro-Fit , with results of controlled clinical trials . METHODS An interdisciplinary group education and exercise program with 36 sessions over 12 weeks was used . Demographic , clinical , and outcome variables were collected on 149 participants , of whom 71 % completed the program . Outcomes included measures of self-efficacy , pain , physical fitness , function , and coping skills . RESULTS Results of the prospect i ve before-after evaluation showed statistically significant ( P < 0.005 ) improvements in all outcomes except for grip strength . These results were comparable with controlled clinical trials found in the literature . Data suggest that smoking , fibromyalgia support groups , and medications may be important modifiable factors . CONCLUSIONS Results suggest that Fibro-Fit was effective in improving physical impairments and function . Further investigation is required to refine the effective components of these programs and determine how modifiable factors can be used to improve outcomes OBJECTIVE To compare the relative efficacy and tolerability of amitriptyline , cyclobenzaprine , and placebo in the treatment of fibromyalgia , and to identify predictors of response to amitriptyline and cyclobenzaprine . METHODS Two hundred eight patients who fulfilled the American College of Rheumatology criteria for the classification of fibromyalgia were entered into a 6-month prospect i ve , double-blind , multicenter trial and were r and omized to 1 of 3 treatment groups : amitriptyline , cyclobenzaprine , or placebo . RESULTS After 1 month , 21 % , 12 % , and 0 % of the amitriptyline , cyclobenzaprine , and placebo patients , respectively , had significant clinical improvement  ( amitriptyline versus placebo P = 0.002 , cyclobenzaprine versus placebo P = 0.02 , amitriptyline versus cyclobenzaprine P not significant ) . These percentages increased to 36 % , 33 % , and 19 % , respectively , at the 6-month assessment ( P not significant ) . The nature and frequency of side effects reported by patients treated with amitriptyline and those reported by patients treated with cyclobenzaprine were similar . A normal Minnesota Multiphasic Personality Inventory ( MMPI ) profile at baseline was predictive of clinical improvement at the 1-month evaluation ( odds ratio 3.3 , 95 % confidence interval 1.2 - 9.0 ) . However , neither the MMPI profile nor any of the demographic , clinical , or functional parameters evaluated at baseline predicted long-term response . CONCLUSION Our data confirm the short-term efficacy of amitriptyline and cyclobenzaprine in a small percentage of patients with fibromyalgia . Long-term efficacy could not be demonstrated because of a higher-than-expected placebo response . Predictors of response to these drugs could not be determined OBJECTIVE To determine the effectiveness of self-management education and physical training in decreasing fibromyalgia ( FMS ) symptoms and increasing physical and psychological well being . METHODS A pretest-posttest control group design was used . Ninety-nine women with FMS were r and omly assigned to 1 of 3 groups ; 86 completed the study . The education only group received a 6-week self-management course . The education plus physical training group received the course and 6 h of training design ed to assist them to exercise independently . The control group got treatment after 3 months . RESULTS The experimental programs had a significant positive impact on quality of life and self-efficacy . Helplessness , number of days feeling bad , physical dysfunction , and pain in the tender points decreased significantly in one or both of the treated groups when retested 6 weeks after the end of the program . Longterm followup of 67 treated subjects showed significant positive changes on the Fibromyalgia Impact Question naire primarily in the physical training group . Among all subjects , 87 % were exercising at least 3 times/week for 20 min or more ; 46 % said they had increased their exercise level since participating in the program ; 70 % were practicing relaxation strategies as needed ; 46 % were working at least half time as opposed to 37 % at pretest . CONCLUSION Self-efficacy of the treated groups was enhanced significantly by the program . Other changes were smaller and more delayed than had been expected . Recommendations for future trials include a longer education program , more vigorous physical training , and longterm followup A multidimensional evaluation of 78 patients with primary fibrositis/fibromyalgia syndrome ( PFS ) revealed no significant relationship between clinical measures of physical discomfort and psychological measures . This observation provided evidence against the notion that the pain of PFS has a psychological etiology . The same patients were r and omized into 4 groups for treatment with ibuprofen and /or alprazolam in a r and omized , double-blind , double-dummy , placebo-controlled pilot trial . Clinical improvement in patient rating of disease severity and in the severity of tenderness upon palpation was most apparent in the subgroup of patients who were receiving both ibuprofen and alprazolam . An 8-week , open-label study in which 52 patients received both drugs further documented improvement in outcome measures . These data indicate that treatment with a combination of ibuprofen and alprazolam can be beneficial for some patients with PFS OBJECTIVE To determine the safety , feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome ( FMS ) . METHODS Fifteen women with confirmed FMS were monitored for injury and exercise compliance , and assessed for muscle strength ( 1-repetition maximum technique ) , cardiovascular endurance ( 6-minute walk test ) , and functional status ( Fibromyalgia Impact Question naire [ FIQ ] ) before and after a 20-week exercise intervention . RESULTS Zero injuries and an 81 % compliance rate occurred during training . Improvement was seen in muscle strength of the lower ( 191 + /- 75 to 265 + /- 67 pounds ; P < 0.001 ) and upper ( 61 + /- 18 to 76 + /- 18 pounds ; P < 0.001 ) body , 6-minute walk distance ( 530 + /- 80 to 629 + /- 74 meters ; P < 0.001 ) , and in FIQ score ( 44 + /- 9 to 32 + /- 14 ; P < 0.01 ) . CONCLUSION A program of progressive strength training and cardiovascular exercise can be safe , well tolerated , and effective at improving muscle strength , cardiovascular endurance and functional status in women with FMS without exacerbating symptoms . This program may also contribute to a reduction in the severity of several symptoms OBJECTIVE To test the efficacy of a grade d aerobic exercise programme in the  chronic fatigue syndrome .  DESIGN R and omised controlled trial with control treatment crossover after the first follow up examination . SETTING Chronic fatigue clinic in a general hospital department of psychiatry . SUBJECTS 66 patients with the chronic fatigue syndrome who had neither a psychiatric disorder nor appreciable sleep disturbance . INTERVENTIONS R and om allocation to 12 weeks of either grade d aerobic exercise or flexibility exercises and relaxation therapy . Patients who completed the flexibility programme were invited to cross over to the exercise programme afterwards . MAIN OUTCOME MEASURE The self rated clinical global impression change score , " very much better " or " much better " being considered as clinical ly important . RESULTS Four patients receiving exercise and three receiving flexibility treatment dropped out before completion . 15 of 29 patients rated themselves as better after completing exercise treatment compared with eight of 30 patients who completed flexibility treatment . Analysis by intention to treat gave similar results ( 17/33 v 9/33 patients better ) . Fatigue , functional capacity , and fitness were significantly better after exercise than after flexibility treatment . 12 of 22 patients who crossed over to exercise after flexibility treatment rated themselves as better after completing exercise treatment 32 of 47 patients rated themselves as better three months after completing supervised exercise treatment 35 of 47 patients rated themselves as better one year after completing supervised exercise treatment . CONCLUSION These findings support the use of appropriately prescribed grade d aerobic exercise in the management of patients with the chronic fatigue syndrome OBJECTIVE To compare a supervised 12-week aerobic exercise class with unsupervised home aerobic exercises in the treatment of patients with fibromyalgia . METHODS This was a 48-week r and omized single ( observer ) blind study in a teaching hospital rheumatology and physiotherapy department . The subjects were 74 patients who fulfilled the American College of Rheumatology criteria for fibromyalgia . Results and conclusions . A 12-week exercise class programme with home exercises demonstrated no benefit over a single physiotherapy session with home exercises in the treatment of pain in patients with fibromyalgia . Neither group ( nor the groups combined ) showed an improvement in pain compared with baseline . There was some significant benefit in psychological well-being in the exercise class group and perhaps a slowing of functional deterioration in this group OBJECTIVE To identify predictors of maintenance of exercise for women with fibromyalgia ( FM ) . METHODS Women with FM who had been r and omized to the exercise arm of a clinical trial were studied prospect ively during and 3 months following treatment . Subjects completed exercise logs weekly and returned the data via postal mail . Outcome variables were duration of aerobic and stretching exercises .  Two separate multivariate models for longitudinal data were built with adjustment for in-treatment adherence and time . Pretreatment characteristics ( self efficacy , pain , disability , stress , exercise barriers and benefits , and age ) and changes during treatment ( pain , disability , stress , and exercise barriers and benefits ) were considered potential predictors of exercise maintenance . RESULTS  Stretching  significantly decreased in the 3 months following treatment . High stress at baseline and increases in stress during treatment were associated with poor maintenance of stretching . Disability at baseline ( measured with the Fibromyalgia Impact Question naire ) , an increase in barriers to exercise during treatment , and increases in upper-body pain during treatment were associated with worse maintenance of aerobic exercise in the 3 months following treatment . CONCLUSION The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress , pain , barriers to exercise , and disability
target: Although some systematic review s have not established an unequivocal benefit of physical training , most authors report a benefit for patients with chronic pain or fatigue .
background: OBJECTIVE To review the published information on physical training for fibromyalgia ( FM ) and related syndromes .