Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial

Kaisa Mannerkorpi, Lena Nordeman, Asa Cider, Gunilla Jonsson, Kaisa Mannerkorpi, Lena Nordeman, Asa Cider, Gunilla Jonsson

Abstract

Introduction: The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking (NW) on functional capacity and pain in fibromyalgia (FM).

Methods: A total of 67 women with FM were recruited to the study and randomized either to moderate-to-high intensity Nordic Walking (n = 34, age 48 ± 7.8 years) or to a control group engaging in supervised low-intensity walking (LIW, n = 33, age 50 ± 7.6 years). Primary outcomes were the six-minute walk test (6MWT) and the Fibromyalgia Impact Questionnaire Pain scale (FIQ Pain). Secondary outcomes were: exercise heart rate in a submaximal ergometer bicycle test, the FIQ Physical (activity limitations) and the FIQ total score.

Results: A total of 58 patients completed the post-test. Significantly greater improvement in the 6MWT was found in the NW group (P = 0.009), as compared with the LIW group. No between-group difference was found for the FIQ Pain (P = 0.626). A significantly larger decrease in exercise heart rate (P = 0.020) and significantly improved scores on the FIQ Physical (P = 0.027) were found in the NW group as compared with the LIW group. No between-group difference was found for the change in the FIQ total. The effect sizes were moderate for the above mentioned outcomes.

Conclusions: Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise, resulting in improved functional capacity and a decreased level of activity limitations. Pain severity did not change over time during the exercise period.

Trial registration: Clinicaltrials.gov identifier NCT00643006.

Figures

Figure 1
Figure 1
Participants' flow.

References

    1. Gran JT. The epidemiology of chronic generalized musculoskeletal pain. Best Pract Res Clin Rheumatol. 2003;17:547–561. doi: 10.1016/S1521-6942(03)00042-1.
    1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P. et al.The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160–172. doi: 10.1002/art.1780330203.
    1. Mannerkorpi K, Burckhardt CS, Bjelle A. Physical performance characteristics of women with fibromyalgia. Arthritis Care Res. 1994;7:123–129. doi: 10.1002/art.1790070305.
    1. Mannerkorpi K, Svantesson U, Broberg C. Relationships between performance-based tests and patients' ratings of activity limitations, self-efficacy and pain in fibromyalgia. Arch Phys Med Rehabil. 2006;87:259–264. doi: 10.1016/j.apmr.2005.10.013.
    1. Buckelew SP, Conway R, Parker J, Deuser WE, Read J, Witty TE, Hewett JE, Minor M, Johnson JC, Van Male L, McIntosh MJ, Nigh M, Kay DR. Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res. 1998;11:196–209. doi: 10.1002/art.1790110307.
    1. Valim V, Oliveira L, Suda A, Silva L, de Assis M, Barros Neto T, Feldman D, Natour J. Aerobic fitness effects in fibromyalgia. J Rheumatol. 2003;30:1060–1069.
    1. Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle A. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol. 1994;21:714–720.
    1. Gowans SE, deHueck A, Voss S, Richardson M. A randomised controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res. 1999;12:120–128. doi: 10.1002/1529-0131(199904)12:2<120::AID-ART7>;2-4.
    1. Gowans SE, deHueck A, Voss S, Silaj A, Abbey SE, Reynolds WJ. Effect of a randomized controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis Rheum. 2001;45:519–529. doi: 10.1002/1529-0131(200112)45:6<519::AID-ART377>;2-3.
    1. Mannerkorpi K, Nyberg B, Ahlmén M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. J Rheumatol. 2000;27:2473–2481.
    1. Mannerkorpi K, Nordeman L, Ericsson A, Arndorw M. Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses. J Rehabil Med. 2009;41:751–760. doi: 10.2340/16501977-0409.
    1. Altan L, Bingöl U, Aykaç M, Koç Z, Yurtkuran M. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int. 2004;24:272–277. doi: 10.1007/s00296-003-0371-7.
    1. Cedraschi C, Desmeules J, Rapiti E, Baumgartner E, Cohen P, Finckh A, Allaz AF, Vischer TL. Fibromyalgia: a randomised, controlled trial of a treatment programme based on self-management. Ann Rheum Dis. 2004;63:290–296. doi: 10.1136/ard.2002.004945.
    1. Assis MR, Silva LE, Alves AM, Pessanha AP, Valim V, Feldman D, Neto TL, Natour J. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis Rheum. 2006;55:57–65. doi: 10.1002/art.21693.
    1. Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007. p. CD003786.
    1. van Santen M, Bolwijn P, Landewé R, Verstappen F, Bakker C, Hidding A, van Der Kemp D, Houben H, van der Linden S. High or low intensity aerobic fitness training in fibromyalgia: does it matter? J Rheumatol. 2002;29:582–587.
    1. Nørregaard J, Bülow PM, Lykkegaard JJ, Mehlsen J, Danneskiold-Samsøoe B. Muscle strength, working capacity and effort in patients with fibromyalgia. Scand J Rehabil Med. 1997;29:97–102.
    1. Bergman S, Herrström P, Jacobsson LT, Petersson IF. Chronic widespread pain: a three year follow up of pain distribution and risk factors. J Rheumatol. 2002;29:818–825.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–381.
    1. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T. Exercise standards for testing and training. A statement for healthcare professionals from the American Heart Association. Circulation. 2001;104:1694–1740. doi: 10.1161/hc3901.095960.
    1. Mannerkorpi K, Svantesson U, Carlsson J, Ekdahl C. Tests of functional limitations in fibromyalgia syndrome: a reliability study. Arthritis Care Res. 1999;12:193–199. doi: 10.1002/1529-0131(199906)12:3<193::AID-ART6>;2-N.
    1. Burckhardt C, Clark S, Bennet R. The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991;18:728–733.
    1. Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7:218–221.
    1. Wohlfart B, Farazdaghi GR. Reference values for the physical work capacity on a bicycle ergometer for men - a comparison with a previous study on women. Clin Physiol Funct Imaging. 2003;23:166–170. doi: 10.1046/j.1475-097X.2003.00491.x.
    1. Ericsson A, Mannerkorpi K. Assessment of fatigue in patients with fibromyalgia and chronic widespread pain. Reliability and validity of the Swedish version of the MFI-20. Disabil Rehabil. 2007;29:1665–1670. doi: 10.1080/09638280601055782.
    1. Mannerkorpi K, Hernelid C. Leisure time physical activity instrument and Physical Activity at Home and Work instrument. Development, face validity, construct validity and test-retest reliability for subjects with fibromyalgia. Disabil Rehabil. 2005;27:695–701. doi: 10.1080/09638280400009063.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Kosek E, Ekholm J, Nordemar R. A comparison of pressure pain thresholds in different tissues and body regions. Scand J Rehabil Med. 1993;25:117–124.
    1. Fayers PM, Machin D. Quality of Life. Assessment, Analysis and Interpretation. Toronto: John Wiley & Sons, Ltd; 2001.
    1. Croft P, Schollum J, Silman A. Population study of tender point counts and pain as evidence of fibromyalgia. BMJ. 1994;309:696–699.
    1. Häuser W, Klose P, Langhorst J, Moradi B, Steinbach M, Schiltenwolf M, Busch A. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther. 2010;12:R79. doi: 10.1186/ar3002.
    1. Jones KD, Liptan GL. Exercise interventions in fibromyalgia: clinical applications from the evidence. Rheum Dis Clin North Am. 2009;35:373–391. doi: 10.1016/j.rdc.2009.05.004.
    1. Staud R, Robinson ME, Price DD. Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls. Pain. 2005;118:176–184. doi: 10.1016/j.pain.2005.08.007.
    1. Staud R, Vierck CJ, Robinson ME, Price DD. Overall fibromyalgia pain is prediced by ratings of local pain and pain-related affect - possible role of peripheral tissues. Rheumatology (Oxford) 2006;45:1409–1415. doi: 10.1093/rheumatology/kel121.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren