Background/Purpose:

Fibromyalgia (FM) is a chronic pain condition leading to reduced physical function. Exercise training is recommended for people with FM. We examined randomized controlled trials (RCTs) to evaluate benefits and harms of aquatic exercise training (AQ) in adults with FM.

Methods:

We searched 9 electronic databases. Selection criteria included full text publication of an RCT of AQ for adults diagnosed with FM, and provision of between-group outcome data. Studies were excluded if exercise in water was <50% of the full intervention. Pairs of reviewers independently screened and selected articles, assessed risk of bias, and extracted data on 24 outcomes in 4 domains: wellness, symptoms, physical fitness and adverse effects. Discordance was resolved through discussion. Benefits and harms of the interventions were evaluated using standardized mean differences (SMD) and 95% CI, with meta-analysis carried out when applicable.

Results:

We screened 1856 citations, 766 abstracts, and 156 full-text articles. Fourteen RCTs examined AQ with a total of 820 participants. AQ was compared to control (9 studies) and to land exercise (5 studies). Risk of bias was rated low for randomization, incomplete outcome data, selective reporting, other bias, and blinding of outcome assessors. Allocation concealment, and blinding of participants and care providers were rated as unclear or high risk. Differences (SMD [95% CI]) between the AQ vs control were: multidimensional function -0.55 [-0.83, -0.27], self-reported physical function -0.44 [-0.76, -0.11], pain -0.53 [-0.76, -0.31], stiffness -1.08 [-2.05, -0.11], strength 0.63 [0.20, 1.05], and cardiovascular submaximal function 0.56 [0.27, 0.85] all favouring AQ (p < 0.05). Attrition was similar in AQ and control groups. Adverse effects were poorly reported, with no serious adverse effects reported. Differences (SMD [95%CI] for AQ compared to land exercise were: strength -0.74 [-1.44, -0.04] favoring land, and sleep -0.75 [-1.32, -0.17] favoring AQ. Older participants with longer disease duration and less pain/impact of disease at baseline responded better to AQ than their counterparts. Greater exercise frequency, accumulated pool time, and length of program were also associated with better results

Conclusion:

Low to moderate quality evidence suggests that AQ is beneficial for improving wellness, symptoms and fitness and that no serious adverse effects result from the intervention. Very low to moderate quality evidence suggests that there are no differences in benefits between AQ and land exercise except in muscle strength (evidence favoring land) and sleep (one study favoring aquatic).

 

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« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/aquatic-exercise-training-for-fibromyalgia-a-systematic-review/