Flexibility exercise training for adults with fibromyalgia Cochrane Systematic Review 2 Sep 2019

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Abstract
available in
Background
Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus targeting major muscle‐tendon units. This review is one of a series of reviews updating the first review published in 2002.

Objectives
To evaluate the benefits and harms of flexibility exercise training in adults with fibromyalgia.

Search methods
We searched the Cochrane Library, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Thesis and Dissertation Abstracts, AMED (Allied and Complementary Medicine Database), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up to December 2017, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.

Selection criteria
We included randomized trials (RCTs) including adults diagnosed with fibromyalgia based on published criteria. Major outcomes were health‐related quality of life (HRQoL), pain intensity, stiffness, fatigue, physical function, trial withdrawals, and adverse events.

Data collection and analysis
Two review authors independently selected articles for inclusion, extracted data, performed 'Risk of bias' assessments, and assessed the certainty of the body of evidence for major outcomes using the GRADE approach. All discrepancies were rechecked, and consensus was achieved by discussion.
Click to expand...

Authors' conclusions

When compared with aerobic training, it is uncertain whether flexibility improves outcomes such as HRQoL, pain intensity, fatigue, stiffness, and physical function, as the certainty of the evidence is very low.
Flexibility exercise training may lead to little or no difference for all‐cause withdrawals. It is also uncertain whether flexibility exercise training has long‐term effects due to the very low certainty of the evidence. We downgraded the evidence owing to the small number of trials and participants across trials, as well as due to issues related to unclear and high risk of bias (selection, performance, and detection biases).
While flexibility exercise training appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events was scarce, therefore its safety is uncertain.
Click to expand...
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013419/full
 
The main finding from this seems to be that most research of this sort is of such poor quality as to be useless. It might be interesting to find out how much money was wasted on running all those useless trials, and how much academic promotion etc was based on such publications.
 
I can personally attest to a large increase in pain with certain mild stretching exercises.

Because of central sensitization in fibro, certain muscle areas are always problematic and any eccentric muscle contraction will result in increased pain, sometimes severe.

I've had episodes where lifting a fork is too painful (trapezius involvement).
 
podcast about this review
People with fibromyalgia have persistent, widespread body pain and there are more than 30 Cochrane Reviews of interventions that might help them. In September 2019, a new review was added to the Cochrane Library, studying the effects of flexibility exercise training. We asked its lead author, Soo Kim from the University of Saskatchewan in Canada, to tell us about the findings.
Click to expand...

https://www.cochrane.org/news/podcast-flexibility-exercise-training-adults-fibromyalgia
 
My personal experience with fibromyalgia and the advice to stretch throughout the day:

Muscles feel extremely tight (semblance in the nerves to spasms) and cannot be stretched because of impedance (again in the tissue and/or in the nervous system).

It is only after pain medication (low dose opioid in my case is very effective) and a muscle relaxant and perhaps a hot bath or deep heat, stretching is possible, ie. only then will I feel a normal relief of tightness from stretching a muscle (albeit very transient).

Stretching extremely tight muscles is not recommended and is not possible without those measures mentioned above.

Again, the main issue with fibro should be to reduce pain and muscle 'tightness'. Stretching alone does not accomplish that. Not going to improve quality of life.
 
And it looked like they only had one trial with a minimal intervention control group, which had no significant differences either. I'd have been interested in having that result in the abstract/summary too.

A lot of Cochrane reviews on issue I'm interested in just don't seem worth reading tbh.
 
Last edited:
You must log in or register to reply here.
Back
Top Bottom