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Fibromyalgia: mind and body techniques that help

MagazineApril 2011 (Vol. 22 Issue 1)Fibromyalgia: mind and body techniques that help

If you're suffering from fibromyalgia, exercise is probably the last thing you feel like doing

If you're suffering from fibromyalgia, exercise is probably the last thing you feel like doing. But the evidence is stacking up to show that keeping active might be the best way to combat this painful chronic condition.

Several studies published over the last few years have found that regular physical activity-even just walking-may help alleviate the devastating symptoms of fibromyalgia, which include wide-spread pain, fatigue, disturbed sleep, stiffness, reduced physical functionality and depression.
In one of the latest studies, published earlier this year in an international peer-reviewed journal, Nordic walking-a fitness technique that involves walking with specially designed poles-was revealed to improve the physical capacity of women with fibromyalgia.

A total of 58 women completed the study, which compared moderate-to-high-intensity Nordic walking (twice a week for 15 weeks) with supervised, low-intensity walking (as the control condition). The results showed that both groups enjoyed "clinically meaningful reductions in pain and fatigue". However, compared with the control group, the Nordic walkers experienced significant fitness gains and had significantly improved scores on a fibromyalgia-specific questionnaire assessing physical function.

What's more, Nordic walking did not trigger any flareups of fibromyalgia symptoms, which can happen with some other forms of high-intensity exercise.
"Nordic walking . . . offers patients a safe and effective means of regaining functionality and physical fitness," the study authors concluded (Arthritis Res Ther, 2011; 13: 103).

Another study-published in the same international journal, but last year-demonstrated that even short bursts of physical activity, such as gardening or housework, can be beneficial for fibromyalgia sufferers.

In this report, researchers at John Hopkins University and the University of Michigan in the US investigated the effects of 30 minutes of lifestyle physical activity (LPA), five to seven days a week, on physical functionality, pain and other measures of disability in 84 relatively inactive fibromyalgia patients.
LPA involves doing moderate-intensity physical activities (intense enough to cause heavy breathing, but not to the extent that you can't hold a conversa-tion) based around everyday life, such as taking the stairs instead of the lift or vacuuming the house.

After 12 weeks, the findings showed that, compared with controls (who were only given information and support), the LPA group reported improved physical function and reduced pain-and these results were statistically significant (Arthritis Res Ther, 2010; 12: R55).

As Kevin Fontaine, lead author of the study, stated, "The nature of fibromyalgia's symptoms, the body pain and fatigue, make it hard for people with this malady to participate in traditional exercise. 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."

However, a follow-up study that tracked the participants for 12 months suggests that the effects of LPA are rather short-lived. Although the LPA group reported greater perceived improvement at six and at 12 months, they no longer differed from the controls in terms of pain, physical activity, body point tenderness, fatigue and depress-ion (J Clin Rheumatol, 2011; 17: 64-8).

The researchers noted that activity levels declined over the course of the study, suggesting that the participants had difficulty adhering to the LPA recommendations.

Mind-body techniques

Another type of activity that may help fibromyalgia sufferers is exercise that involves the mind as well as the body.

Yoga, for example, relieved a variety of fibromyalgia symptoms, including pain, fatigue and depression. In this study, 53 women were randomized to receive either an eight-week yoga programme (involving gentle poses, meditation, breathing exercises and group discussions) or standard care. The results with yoga were clinically significant: pain was reduced by an average of 24 per cent, fatigue by 30 per cent and depression by 42 per cent (Pain, 2010; 151: 530-9).

Crucially, participants showed a strong commitment to the yoga. "Attendance at the classes was good as was most partici-pants' willingness to practice yoga while at home," said study author James Carson. However, further research is needed to see if yoga is an effective therapy in the long term.
Another promising mind-body technique is tai chi, which combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation.

In this trial, 66 fibromyalgia patients were assigned to either tai chi classes (one-hour sessions twice a week for 12 weeks) or a control intervention of wellness education and stretching. At the end of the study, the tai chi group showed clinically signifi-cant improvements in symptoms, as measured by the Fibromyalgia Impact Questionnaire. In particular, tai chi was associated with reduced pain and depression, and better sleep and quality of life. No adverse effects were reported and the benefits were sustained for 24 weeks (N Engl J Med, 2010; 363: 743-54).

But if faster-paced exercise is preferred, it may be worthwhile combining your favourite aerobic exercise with simple relaxation techniques such as deep breathing and visualization (adding these to the end of your workout). In a study from Spain, fibromyalgia patients who participated in an aerobic exercise programme combined with progressive relaxation techniques experienced significant improve-ment compared with the control group, which received sham magnetic therapy. After 10 weeks, the exercise + relaxation group reported better sleep, reduced anxiety and improved quality of life (Med Clin [Barc], 2011 Feb 21; Epub ahead of print).

Clearly, drugs are not the only answer to fibromyalgia, as studies are now suggesting that aerobic exercise and mind-body techniques are effective. Never-theless, more research is needed to see how these interventions fare in the long-term, although it appears that if you can stick with it, you will continue to reap the benefits. For best results, work with a physical therapist who can devise an exercise programme that's right for you.

Joanna Evans

Factfile: Other approaches

u Try TCM. According to a recent review, Traditional Chinese Medicine (TCM) appears to be effective against fibromyalgia. Studies show that acupuncture, Chinese herbs, and a combination of acupuncture and cupping are more successful at reducing pain than are conventional drug treatments (J Altern Complement Med, 2010; 16: 397-409).
u Give homeopathy a go. In a double-blind, randomized controlled trial (RCT, considered the 'gold standard' for scientific evaluation), individualized homeopathy proved to be "significantly better than placebo in lessening tender point pain and improving the quality of life and global health of persons with fibromyalgia" (Rheumatology [Oxford], 2004; 43: 577-82).
More recently, a review of the findings of RCTs so far revealed that homeopathy is consistently better than a placebo at alleviating the symptoms of fibromyalgia. However, the researchers noted that more rigorous trials are needed (Clin Rheumatol, 2010; 29: 457-64).
u Consider massage. A particular technique called 'myofascial release therapy' was found to improve pain, quality of sleep, anxiety levels and quality of life in a 20-week RCT study of 74 fibromyalgia patients (Evid Based Complement Alternat Med, 2011; 2011: 561753).
u Go vegan. A vegan diet-which includes no animal products-might be helpful for fibromyalgia, according to a study of 33 fibromyalgia patients who were split into two groups-one following a strict, low-salt vegan diet consisting of only raw foods, and one that continued with an omnivorous diet. After three months, the vegan dieters saw significant improvements in their overall health, with less pain and stiffness, too (Scand J Rheumatol, 2000; 29: 308-13).
However, these beneficial effects could simply be down to the fact that the participants lost weight-most were overweight at the beginning of the study, and shifting to a vegan diet caused significant reductions in their body mass index (BMI). As several studies have found a link between obesity and fibromyalgia (J Pain, 2010; 11: 1329-37), it may perhaps be that the weight loss rather than the vegan diet per se was responsible for the improvements.
u Eliminate harmful food additives. There is evidence to suggest that the artificial sweetener aspartame and the flavour enhancer monosodium glutamate (MSG)-both known to be 'excitotoxins'-may be involved in fibromyalgia. One study describes four women with fibromyalgia who saw complete or nearly complete resolution of their symptoms within months of eliminating MSG or MSG plus aspartame from their diet. More important, symptoms recurred whenever they ingested the chemicals again.
"We propose that these four patients may represent a subset of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or, alternatively, may comprise an excitotoxin syndrome that is similar to fibromyalgia," the researchers said (Ann Pharmacother, 2001; 35: 702-6).
In a case report including a woman with fibromyalgia, her symptoms completely disappeared after she stopped consuming aspartame (Clin Exp Rheumatol, 2010; 28 [6 Suppl 63]: S131-3).
u Try supplements. 5-Hydroxytryptophan (5-HTP; 100 mg three times a day) and S-adenosylmethionine (SAMe; 800 mg per day) may be effective for fibromyalgia, according to double-blind trials (J Int Med Res, 1990; 18: 201-9; Scand J Rheumatol, 1991; 20: 294-302). Other potentially useful supplements include vitamin D (Clin Rheumatol, 2007; 26: 551-4), magnesium with malic acid (J Rheumatol, 1995; 22: 953-8), and antioxidants such as vitamins C and E (Redox Rep, 2006; 11: 131-5). Many fibromyalgia sufferers are deficient in these and other nutrients, so it may be worth getting tested to see what you're low in.
u Check your thyroid. According to Dr John Lowe of the Fibromyalgia Research Foundation in Boulder, CO, many of the features of fibromyalgia and hypothyroidism (an underactive thyroid) are virtually identical, and thyroid hormone treatment trials have reduced or eliminated fibromyalgia symptoms as well (Med Sci Monit, 2006; 12: CR282-9).
For this reason, it may prove useful to investigate the possibility of having hypothyroidism, and to seek out natural treatments if you do (see WDDTY vol 20 no 10, pages 18-9).

WDDTY VOL. 22 NO. 1


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