Resistance training (such as weight-lifting) for fibromyalgia

Research question

What are the effects of resistance exercise training for people with fibromyalgia on wellness, symptoms, fitness, and adverse effects?

Background

What problems does fibromyalgia cause? People with fibromyalgia have chronic, widespread body pain, and often have fatigue (feeling tired), stiffness, depression and problems sleeping.

What is resistance training? Resistance training is exercise that involves lifting weights, or using machines or elastic bands that provide resistance to movement.

- This review only looked at resistance training programs supervised by a trained professional.

- We compared resistance training to no exercise and to other types of exercise.

Study characteristics

After looking for all related studies in March 2013, we found 5 studies with 219 women with fibromyalgia. Ninety-five (95) of these women did resistance training.

Only three studies looked at wellness, symptoms, and fitness in 54 women with fibromyalgia who did resistance training and 53 women with fibromyalgia who did not do resistance training.

The 54 women with fibromyalgia who did resistance training:

- did supervised resistance training sessions using exercise equipment, free weights, and body weight

- exercised 2 to 3 times a week

- exercised for 16 to 21 weeks.

Key results: what happened to women with fibromyalgia who took part in resistance training for 16 to 21 weeks compared to those who did not do resistance training during this time period?

Overall well-being (multidimensional function) on a scale of 0 to 100 units

Women who did resistance training rated their well-being 25 units better while women who did not do resistance training rated their well-being 8 units better.

Therefore, women who did resistance training rated their well-being 17 units better at the end of the studies than those who did not do resistance training.

Physical function (ability to do normal activities) on a scale of 0 to 100 units

Women who did resistance training rated their ability to do normal activities 8 units better while women who did not do resistance training rated their ability to do normal activities 2 units better.

Therefore, women who did resistance training rated their ability to function 6 units better at the end of the studies than women who did not do resistance training.

Pain on a scale of 0 to 10 units

Women who did resistance training rated their pain 3.5 units better while women who did not do resistance training rated their pain 1 unit better.

Therefore, women who did resistance training rated their pain 2.5 units better at the end of the studies than women who did not do resistance training.

Tenderness estimated by number of points (out of 18) perceived as painful with 4 kilograms of pressure

Women who did resistance training had 4 fewer tender points while women who did not do resistance training had 2 fewer tender points.

Therefore, women who did resistance training had 2 fewer tender points at the end of the studies than women who did not do resistance training.

Muscle strength

Women who did resistance training could lift 28 kilograms more while women who did not do resistance training could lift 1 kilogram more.

Therefore, women who did resistance training could lift 27 kilograms more at the end of the studies than women who did not do resistance training.

Dropping out (number of women out of 100 who dropped out of the studies)

Thirteen women who did resistance training dropped out while 4 women who did not do resistance training dropped out.

Therefore, 9 more women out of 100 who did resistance training dropped out of the studies than women who did not do resistance training.

Conclusions

For women with fibromyalgia, resistance training for 16 to 21 weeks likely improves

- ability to do normal activities

- pain, tenderness, muscle strength and overall well-being.

Quality of the evidence

- Because so few studies have been done so far, more research is likely to change these results.

- While we do not have exact information about side effects experienced by women with fibromyalgia during the studies, no injuries were reported.

- We do not know if the results would be the same for men, because only women took part in the studies.

Authors' conclusions: 

The evidence (rated as low quality) suggested that moderate- and moderate- to high-intensity resistance training improves multidimensional function, pain, tenderness, and muscle strength in women with fibromyalgia. The evidence (rated as low quality) also suggested that eight weeks of aerobic exercise was superior to moderate-intensity resistance training for improving pain in women with fibromyalgia. There was low-quality evidence that 12 weeks of low-intensity resistance training was superior to flexibility exercise training in women with fibromyalgia for improvements in pain and multidimensional function. There was low-quality evidence that women with fibromyalgia can safely perform moderate- to high-resistance training.

Read the full abstract...
Background: 

Fibromyalgia is characterized by chronic widespread pain that leads to reduced physical function. Exercise training is commonly recommended as a treatment for management of symptoms. We examined the literature on resistance training for individuals with fibromyalgia. Resistance training is exercise performed against a progressive resistance with the intention of improving muscle strength, muscle endurance, muscle power, or a combination of these.

Objectives: 

To evaluate the benefits and harms of resistance exercise training in adults with fibromyalgia. We compared resistance training versus control and versus other types of exercise training.

Search strategy: 

We searched nine electronic databases (The Cochrane Library, MEDLINE, EMBASE, CINAHL, PEDro, Dissertation Abstracts, Current Controlled Trials, World Health Organization (WHO) International Clinical Trials Registry Platform, AMED) and other sources for published full-text articles. The date of the last search was 5 March 2013. Two review authors independently screened 1856 citations, 766 abstracts and 156 full-text articles. We included five studies that met our inclusion criteria.

Selection criteria: 

Selection criteria included: a) randomized clinical trial, b) diagnosis of fibromyalgia based on published criteria, c) adult sample, d) full-text publication, and e) inclusion of between-group data comparing resistance training versus a control or other physical activity intervention.

Data collection and analysis: 

Pairs of review authors independently assessed risk of bias and extracted intervention and outcome data. We resolved disagreements between the two review authors and questions regarding interpretation of study methods by discussion within the pairs or when necessary the issue was taken to the full team of 11 members. We extracted 21 outcomes of which seven were designated as major outcomes: multidimensional function, self reported physical function, pain, tenderness, muscle strength, attrition rates, and adverse effects. We evaluated benefits and harms of the interventions using standardized mean differences (SMD) or mean differences (MD) or risk ratios or Peto odds ratios and 95% confidence intervals (CI). Where two or more studies provided data for an outcome, we carried out a meta-analysis.

Main results: 

The literature search yielded 1865 citations with five studies meeting the selection criteria. One of the studies that had three arms contributed data for two comparisons. In the included studies, there were 219 women participants with fibromyalgia, 95 of whom were assigned to resistance training programs. Three randomized trials compared 16 to 21 weeks of moderate- to high-intensity resistance training versus a control group. Two studies compared eight weeks of progressive resistance training (intensity as tolerated) using free weights or body weight resistance exercise versus aerobic training (ie, progressive treadmill walking, indoor and outdoor walking), and one study compared 12 weeks of low-intensity resistance training using hand weights (1 to 3 lbs (0.45 to 1.36 kg)) and elastic tubing versus flexibility exercise (static stretches to major muscle groups).

Statistically significant differences (MD; 95% CI) favoring the resistance training interventions over control group(s) were found in multidimensional function (Fibromyalgia Impact Questionnaire (FIQ) total decreased 16.75 units on a 100-point scale; 95% CI -23.31 to -10.19), self reported physical function (-6.29 units on a 100-point scale; 95% CI -10.45 to -2.13), pain (-3.3 cm on a 10-cm scale; 95% CI -6.35 to -0.26), tenderness (-1.84 out of 18 tender points; 95% CI -2.6 to -1.08), and muscle strength (27.32 kg force on bilateral concentric leg extension; 95% CI 18.28 to 36.36).

Differences between the resistance training group(s) and the aerobic training groups were not statistically significant for multidimensional function (5.48 on a 100-point scale; 95% CI -0.92 to 11.88), self reported physical function (-1.48 units on a 100-point scale; 95% CI -6.69 to 3.74) or tenderness (SMD -0.13; 95% CI -0.55 to 0.30). There was a statistically significant reduction in pain (0.99 cm on a 10-cm scale; 95% CI 0.31 to 1.67) favoring the aerobic groups.

Statistically significant differences were found between a resistance training group and a flexibility group favoring the resistance training group for multidimensional function (-6.49 FIQ units on a 100-point scale; 95% CI -12.57 to -0.41) and pain (-0.88 cm on a 10-cm scale; 95% CI -1.57 to -0.19), but not for tenderness (-0.46 out of 18 tender points; 95% CI -1.56 to 0.64) or strength (4.77 foot pounds torque on concentric knee extension; 95% CI -2.40 to 11.94). This evidence was classified low quality due to the low number of studies and risk of bias assessment. There were no statistically significant differences in attrition rates between the interventions. In general, adverse effects were poorly recorded, but no serious adverse effects were reported. Assessment of risk of bias was hampered by poor written descriptions (eg, allocation concealment, blinding of outcome assessors). The lack of a priori protocols and lack of care provider blinding were also identified as methodologic concerns.

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