Table 3 Summary of findings from exercise studies in fibromyalgia

1.

Among exercise interventions, the evidence is most supportive of aerobic exercise in the treatment of fibromyalgia.

2.

Aerobic exercise does not consistently improve major symptom domains associated with fibromyalgia, including pain, fatigue, sleep disturbance, or psychological symptoms.

3.

Patients who tolerate and comply with a high level of aerobic exercise intensity that meets the American College of Sport Medicine guidelines for cardiovascular endurance demonstrate improvements in cardiovascular fitness, pain pressure thresholds, global well being, and self-reported physical function.

4.

Many patients do not tolerate high intensity aerobic exercise with reports of increased pain following this intervention.

5.

Low to moderate intensity, graded aerobic exercise (e.g., walking or cycling on a stationary bicycle) may lead to improvements in global assessments, tender points, and quality of life.

6.

Improvements in fibromyalgia with exercise may occur without change in cardiovascular fitness levels, and the mechanisms by which exercise improves fibromyalgia are unclear.

7.

Although optimal intensity, duration, and frequency of exercise have not clearly been established, studies to date suggest that, for many patients, a gradual increase, as tolerated, in exercise to reach a goal of 30 to 60 minutes of low-moderate intensity aerobic exercise (e.g., walking, pool exercises, stationary bike) at least 2 to 3 times a week for more than 10 weeks appears to be associated with positive short-term benefits. Ongoing exercise is associated with maintenance of improvements in fibromyalgia.

8.

Supervised, group exercise interventions may be preferable to home-based exercise regimens, especially at the initiation of an exercise program.

9.

Adherence to exercise is problematic for many patients with fibromyalgia. Factors that contribute to low adherence to exercise include disability, stress, exacerbation of pain, depression, low exercise self-efficacy (i.e., low confidence in the ability to exercise under adverse conditions), barriers to exercise, and low social support.