Brazilian researchers have determined that swimming is as effective as walking to relieve pain and improve quality of life for fibromyalgia patients. The study “Swimming Improves Pain and Functional Capacity of Patients With Fibromyalgia: A Randomized Controlled Trial,” was published in Archives of Physical Medicine and Rehabilitation.
“Physical exercise is an essential component of any treatment for fibromyalgia, and plenty of studies have demonstrated that low-impact aerobic exercise offers the most benefits. However, not everyone likes or is able to do the same kind of physical activity, so our group decided to test alternatives,” Jamil Natour, a professor of rheumatology at the Federal University of São Paulo (UNIFESP), said in a news release.
In a 2003 study, Natour’s research team found that walking was better than stretching for reducing pain, improving depression and other emotional features, and enhancing cardiorespiratory fitness in fibromyalgia patients. In 2006, the same team found that deep-water running was also effective for patients with the condition.
“Swimming hadn’t been evaluated with proper scientific rigor. The results of this clinical trial showed swimming was as beneficial as walking, whose positive effects have clearly been demonstrated. Swimming can be a preferable option for a person who suffers from both fibromyalgia and knee arthrosis, for example,” Natour said.
The new study evaluated the effect of swimming on pain, functional capacity, aerobic capacity, and quality of life in 76 patients with fibromyalgia. Patients were randomly assigned to a swimming group or a walking group. Both groups underwent training sessions overseen by rheumatology experts three times a week for 12 weeks.
Participants were evaluated before the exercise protocols, at 6 weeks, and at 12 weeks after the onset of the protocols. The primary outcome measure was the visual analog scale for pain.
Patients in both groups experienced improvement in pain after the 12-week program, with no difference between groups. Specifically, there was a decrease in pain intensity from 6.2 to 3.6 in the walking group and from 6.4 to 3.1 in the swimming group.
The secondary measurements included the Fibromyalgia Impact Questionnaire and the Medical Outcomes Study 36-Item Short-Form Health Survey for quality of life, a spiroergometric test for cardiorespiratory variables, and the timed Up & Go test for functional performance.
There were significant improvements for both groups in all measurement scales. For example, in social interaction there was an increase from 56 to 80 in the swimming group and from 52 to 72 in the walking group. In mental health, the swimming group and the walking group saw an improvement from 55.7 to 68 and 51.1 to 66.8, respectively.
There were equivalent improvements in the two groups on the Fibromyalgia Impact Questionnaire and on the spiroergometric test.
According to Natour, fibromyalgia patients have chronic diffuse non-inflammatory pain in the musculoskeletal system that comes from a faulty system mechanism which transmits and modulates the transmission of nervous stimuli between the periphery of the body and the brain.
“A prod or poke to a leg or arm may be interpreted as a painful stimulus by a patient with fibromyalgia,” he said. “In addition to magnified pain signals, the patient may experience spontaneous pain. Diffuse tenderness with no anatomical explanation lasting for at least three months is a defining feature of this disease.”
Women are ten times more likely to suffer from fibromyalgia than men. The condition also causes sleep disorders. Patients frequently have reduced levels of the pain sensitivity and mood regulation neurotransmitter called serotonin. Fibromyalgia patients can also have alterations in the autonomic nervous system which is responsible for the control of body functions such as heart rate, sweating, blood vessel contraction, intestinal movements, and salivary flow. The symptoms severely affect quality of life.
“Many patients have no anatomic defects, not even arthrosis, but suffer from worse deterioration in the quality of their lives and functionality than people with joint disease,” Natour said. “Some studies have compared fibromyalgia with ankylosing spondylitis and rheumatoid arthritis, both of which are deforming joint disorders. Also, some 30% of people with fibromyalgia suffer from depression.”
Consensus exists in the medical community that treatment for fibromyalgia should combine pain medications for chronic pain, antidepressants for emotional distress, and regular physical exercise to help control co-existing conditions such as arthrosis that also cause pain.
Fibromyalgia is a serious public health concern as it affects about 5% of women, according to Natour. “But, not being fatal, it isn’t very visible in government statistics,” he said.
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