In a recent blog, we looked at whether exercise affects aerobic function in fibromyalgia (FM) patients. While the review found improvements it was difficult to determine what outcomes improved due to poor reporting. Pain is the hallmark symptom for FM sufferers and it is essential that the principle aim of any intervention is to reduce pain. With regard to exercise, it is often associated with increased pain; both during and after, therefore individuals with FM are reluctant to participate.

Mindfulness based stress reduction (MBSR) programs, which include cognitive behavioural therapy (CBT), imagery, meditation and mindfulness movement (Qigong), have been found to improve symptoms such as pain in patients with FM.

So does a period of mindfulness-based intervention allow an individual to introduce more traditional exercise into their life? A recent systematic review by Henke and Lansen 2014 examines the impact mindfulness based therapies can have on FM sufferers pain and quality of life.

Here’s what they did

• The authors searched 4 online databases to May 2013 for published and unpublished randomised controlled trials, non-randomised controlled trials, quasi-experimental and prospective or retrospective cohort studies for mindfulness based programs on physical and psychological symptoms in individuals with FM.
• Inclusion criteria included a confirmed diagnosis of FM and outcome measures evaluating physical and psychological symptoms.
• Reporting methods were in accordance with PRISMA and the Joanna Briggs Institute guidelines.

Here’s what they found

• 10 studies included – 5 RCTs, 2 controlled cohort studies and 3 non-controlled cohort studies.
• Quality – 6 high quality >70%, 3 moderate quality 50-69% and 1 study was low quality <50%
• Interventions all included mindfulness group design, including CBT, imagery and mindfulness based exercise i.e. Qigong.
• Interventions were 8 weeks, apart from one study that was 10 weeks
• Statistical pooling of the data was not possible due to variability in outcome measures and data presented.

• Pain: improvements in pre to post intervention pain scores were found in 4 out of 6 studies (6 studies reported pain outcome data) only one study with control group flowed benefits in favour of MBSR group
• Sleep: one of 3 studies identified significant improvements
• Fibromyalgia Impact Questionnaire (FIQ) scores: 3 out of the 5 studies reported improvements in the overall % score, mean change of 2.6%

The authors concluded

Mindfulness-based programs, as a mind-body therapy, maybe a promising adjunctive treatment for a range of physical symptoms and psychological distress in patients with fibromyalgia.

The Musculoskeletal Elf’s view

Determining the correct modality and intensity for FM patients to exercise is difficult due to inconsistent messages within the literature. Most papers find benefits in favour of exercise, but the actual prescription and effects on outcomes are limited. Reducing a FM sufferer’s pain should be the primary goal of any intervention, as reduced pain will allow better quality of life and improved function. None of the included papers in the current study evaluated whether individuals who improved with MBSR interventions were able to participate in a more traditional exercise program.

What do you think?

• Have you ever used MBSR as part of your treatment plan in managing FM patients?
• Do you find that a period of MBSR can allow progression to more traditional forms of exercise?

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community. Post your comment below, or get in touch via social media (Facebook, Twitter, LinkedIn, Google+).

Links

• Henke, M. and Hansen, A. C. (2014). The effectiveness of mindfulness-based programs on physical symptoms and psychological distress in patients with fibromyalgia: A systematic review. International Journal of Welbeing, 4(1), 28-45. [full paper]
• PRISMA statement
• EQUATOR Network