Exercises in Water Best at Easing Pain of Fibromyalgia, Review Suggests

Exercises in Water Best at Easing Pain of Fibromyalgia, Review Suggests

Water-based exercise may be more helpful in easing pain and improving quality of life for adults with fibromyalgia than exercises done outside a pool or no physical excise at all, a review study found. 

The review, “Pool-based exercise for amelioration of pain in adults with fibromyalgia syndrome: A systematic review and meta-analysis,” was published in the journal Modern Rheumatology.

Fibromyalgia is characterized by pain, fatigue, and muscle rigidity. Its chronic pain is typically managed through the use of both conventional medications and non-pharmacological interventions such as physical therapy, psychotherapy, and electric stimulation. 

Exercises such as walking, yoga, and pilates have all been shown to help reduce pain and fatigue, improve life quality, alleviate sleep disruption, and boost the mental health of fibromyalgia patients. 

Exercises done in a pool also provide a low-intensity workout that has been shown to ease pain, and relax and strengthen muscles while lessening joint stiffness and muscle spasms.

The appropriate combination of pharmaceutical and alternative treatment varies from patient to patient, however, and many alternative approaches, used as add-on therapies, do not significantly control fibromyalgia symptoms. 

Researchers at the Federal University of Maranhão in Brazil performed a systematic literature review and a meta-analysis — an assessment that combines multiple prior studies — of the impact of water-based exercise compared to either non-water activity or no exercise in adults with fibromyalgia.

Potential eligible studies, published since 1991 in English, Spanish, or Portuguese, investigated physical exercises undertaken in pools in this population. Studies without a control group or in which patients are not randomly assigned a treatment type were excluded, as were those that assessed chronic pain not related to fibromyalgia or that used alternative therapies in parallel with physical exercise.  

In total, 14 studies were included by two independent reviewers. Most trials were conducted in Spain. The mean duration of these interventions was 17 weeks, the average duration of physiotherapy sessions was 53.5 minutes, and the mean number of sessions per week was 2.4.

The visual analog scale (VAS) for pain was the primary outcome in the analysis, while Fibromyalgia Impact Questionnaire (FIQ) score for quality of life was the secondary outcome.

Patients were divided into an intervention group that participated in pool-based exercises in warm water, and a control group whose participants either did not exercise or exercised on land.

Results showed lower VAS and FIQ scores with pool-based exercise in all studies, indicating lesser pain and disease impact on quality of life in comparison to the studies’ start. However, significant VAS score decreases for water-based exercise, in comparison to the control group, were found in only five of the 14 studies. In turn, FIQ scores were significantly lower in seven trials.

Still, the researchers clearly favored a “continuous program of appropriate physical exercises” for this patient group.

“Although exercises performed on both water and soil bring benefits to physical capacity, improvement in pain, depression, anxiety and number of days patients reported feeling good was observed only in the pool exercise group,” they wrote.

These findings suggest that physiotherapy in a pool, particularly a heated pool, can “be an effective tool” for pain relief and a better quality of life in people with fibromyalgia.

“Further research should address other tools for measuring pain scores and disability among individuals with fibromyalgia and recruit a larger number of participants. Overall, well-designed pool-based exercise programs may be useful for fibromyalgia patients to achieve a gradual reduction in pain symptomatology,” the researchers concluded.

According to the scientists, the relatively small number of participants in analyzed clinical trials, their significant dropout rates, and the lack of a long-term analysis of water-based exercise on fibromyalgia symptoms are among the study’s limitations.