Friday, April 2, 2010

Short Bursts of Physical Activity May Reduce Chronic Pain Symptoms

Written by Laurie Barclay, MD, Freelance writer and reviewer, Medscape, LLC

(Medscape) — Short bursts of physical activity in a lifestyle physical activity (LPA) intervention may reduce fibromyalgia (FM) symptoms and improve physical function, according to the results of a randomized trial reported online in the March 29 issue of Arthritis Research & Therapy.

"Fibromyalgia is estimated to occur in 2% of the U.S. general population, affecting about eight times more women than men," said lead author Kevin R. Fontaine, PhD, from Johns Hopkins University School of Medicine, in Baltimore, Maryland, in a news release. "Although exercise has been shown to be beneficial, the symptoms often create obstacles that deter many from exercising consistently enough to derive benefits."

The goal of this study was to assess the effects in 84 minimally active adults with FM of accumulating at least 30 minutes of self-selected LPA on perceived physical function, pain, fatigue, body mass index, depression, tenderness, and the 6-minute walk test. Participants were assigned to either LPA or a FM education control (FME) group receiving information and support.

In the LPA intervention, participants were taught to perform LPA intense enough to cause heavy breathing without preventing conversation. Suitable moderate-intensity physical activities included climbing stairs, gardening, and walking. The goal was to accumulate 30 minutes of self-selected moderate-intensity LPA at 5 to 7 days per week.

A total of 73 (87%) of the 84 participants completed the 12-week trial. Average daily steps in the LPA group increased by 54%. Perceived functional deficits and pain were significantly less in the LPA group vs the FME group (P = .032 and P = .006, respectively). The groups did not differ on 6-minute walk test performance (P = .067), fatigue, depression, body mass index, or tenderness.

"The nature of fibromyalgia's symptoms, the body pain and fatigue, make it hard for people with this malady to participate in traditional exercise," Dr. Fontaine said. "We've shown that LPA can help them to get at least a little more physically active, and that this seems to help improve their symptoms."

Limitations of this study include inability to determine how LPA compares with a traditional no-treatment control group; use of self-reported outcomes; and use of pedometers to assess LPA, which failed to quantify cycling or water exercise. In addition, muscle strength was not measured during the trial, and persons with other comorbid conditions were excluded.

"Accumulating 30 minutes of LPA throughout the day produces clinically relevant changes in perceived physical function and pain in previously minimally active adults with FM," the study authors conclude. "However, the LPA intervention only moved the participants from the sedentary to low physical activity category. This suggests that it is essential to encourage FM patients to increase the duration of their physical activity in ways that do not compromise their ability to sustain the increased level of activity over the intermediate- and long-term."

The National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases supported this study. One of the study authors (Daniel J. Clauw, MD) has acted as a consultant for Pfizer, Lilly, Forest Laboratories, Cypress Biosciences, Pierre Fabre, UCB, and Wyeth, and has received grant support from Pfizer, Cypress Bioscience, and Forest.

Arthr Res Therapy. Published online March 29, 2010

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