BMJ 2002;325:185 ( 27 July )

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Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial

Selwyn C M Richards, consultant rheumatologist, ^a David L Scott, professor of clinical rheumatology. ^b

^a Poole Hospital NHS Trust, Poole, Dorset BH15 2JB, ^b King's College Hospital, London SE22 8PT

Correspondence to: S C M Richards srichards{at}poole-tr.swest.nhs.uk

Objectives: To evaluate cardiovascular fitness exercise in people with fibromyalgia.
Design: Randomised controlled trial.
Setting: Hospital rheumatology outpatients. Group based classes took place at a "healthy living centre."
Participants: 132 patients with fibromyalgia.
Interventions: Prescribed graded aerobic exercise (active treatment) and relaxation and flexibility (control treatment).
Main outcome measures: Participants' self assessment of improvement, tender point count, impact of condition measured by fibromyalgia impact questionnaire, and short form McGill pain questionnaire.
Results: Compared with relaxation exercise led to significantly more participants rating themselves as much or very much better at three months: 24/69 (35%) v 12/67 (18%), P=0.03. Benefits were maintained or improved at one year follow up when fewer participants in the exercise group fulfilled the criteria for fibromyalgia (31/69 v 44/67, P=0.01). People in the exercise group also had greater reductions in tender point counts (4.2 v 2.0, P=0.02) and in scores on the fibromyalgia impact questionnaire (4.0 v 0.6, P=0.07).
Conclusions: Prescribed graded aerobic exercise is a simple, cheap, effective, and potentially widely available treatment for fibromyalgia.

What is already known on this topic Fibromyalgia is common debilitating medically unexplained condition affecting around 1% of the population Current treatments are unsatisfactory and most people remain the same after several years of treatment Exercise as a treatment given by healthcare professionals in highly specialised centres is of some short term benefit What this study adds For people with fibromyalgia prescribed graded aerobic exercise is an effective treatment that leads to improvements in self reported health status Prescribed exercise can be undertaken effectively in the community by personal trainers previously inexperienced in management of people with ill health

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