Exercise training

What is fibromyalgia and what is mixed exercise?
Fibromyalgia is a condition causing chronic pain and soreness throughout the body. People with this condition often feel depressed,
tired, and stiff, and have difficulty sleeping. Mixed exercise is defined as regular sessions of two or more types of exercise including
aerobic (walking or cycling), strengthening (lifting weights or pulling against resistance bands), or flexibility (stretching) exercise.
Study characteristics
Reviewers searched for studies until December 2017, and found 29 studies (2088 people) conducted in 12 different countries. The
average age of study participants was 51 years, and 98% were female. The average exercise programme was 14 weeks long with three
sessions of 50 to 60 minutes per week. All exercise programmes were fully or partially supervised. Reviewers were most interested in
comparing mixed exercise groups to control groups (19 studies; 1065 people). People in control groups either received no treatment or
continued their usual care.
Key results - mixed exercise vs control
Each outcome below is measured on a scale that goes from 0 to 100, where lower scores are better.
Health-related quality of life (HRQL)
After 5 to 26 weeks, people who exercised were 7% better (3% better to 11% better) or improved by 7 points on a 100 point scale.
People who exercised rated their HRQL at 49 points.
People in the control group rated their HRQL at 56 points.
Pain
After 5 to 26 weeks, people who exercised had 5% less pain (1% better to 9% better) or improved by 5 points on a 100 point scale.
People who exercised rated their pain at 53 points.
People in the control group rated their pain at 58.6 points.
Tiredness
After 14 to 24 weeks, people who exercised were 13% less tired (8% better to 18% better) or improved by 13 points on a 100 point
scale
People who exercised rated their tiredness at 59 points.
People in the control group rated their tiredness at 72 points.
Stiffness
After 16 weeks, people who exercised were 7% less stiff (1% better 1 to 12% better) or improved by 7 points on a 100 point scale.
People who exercised rated their stiffness at 61 points.
People in the control group rated their stiffness at 68 points.
Ability to do daily activities (physical function)
After 8 to 24 weeks, people who exercised were 11% better (7% to 15%) or improved by 11 points on a 100 point scale.
People who exercised rated their physical function at 38 points.
People in the control group rated their physical function at 49 points.
Harms - Some participants experienced increased pain, soreness, or tiredness during or after exercise. Studies reported no injuries or
other harms. However, reporting of harms was missing or incomplete in many studies. We are uncertain whether risk is increased with
exercise.
Leaving the study early - 11% of control participants left the study early compared with 12% of exercisers.
Long-term effects - Analysis of long-term effects of HRQL showed maintenance of mixed exercise effects at 6 to 12 weeks and at 13 to
26 weeks but not at 27 to 52 weeks. Very low-quality evidence suggests that it is uncertain whether mixed exercises improve HRQL in
the long term. Withdrawals and adverse events were not measured.
Other - Reviewers found no evidence that the benefits and harms of mixed exercise were any different from education programmes,
cognitive-behavioural training, biofeedback, medication, or other types of exercise.
Conclusions and quality of evidence
Mixed exercise may improve HRQL and the ability to do daily activities, may decrease pain and tiredness, and may be acceptable to
individuals with fibromyalgia. Low-quality evidence suggests that mixed exercise may slightly improve stiffness. When compared to
other exercise or non-exercise interventions, we are uncertain about the effects of mixed exercise. Although mixed exercise appears to
be well tolerated (similar numbers of people leaving the study across groups), evidence on harms was scarce, so we are uncertain about
its safety. Reviewers considered the quality of evidence to be low to moderate because of small numbers of people in the studies, some
issues involving study design, and the low quality of results.

Abstract The effects of a 12-week exercise-training program on cognitive, somatic, and behavioral anxiety and on heart rate responses to evaluative stress were scrutinized in 89 subjects randomly assigned to an experimental (exercise) or a control group. The training program consisted of exercises that were aimed to the improvement of the general physical fitness (i.e., strength, flexibility, and endurance). Following the 12-week training period, exercising subjects showed improved motor skill capacity as well as higher VO(2) max. In an anxiety inciting test situation, that consisted of the video-taped delivery of a 5-min speech, a mental arithmetic and a fine motor task, exercising subjects showed more favourable responses than control subjects in three ways: (a) they exhibited lower behavioral anxiety during the anticipation phase of the three stressors, (b) they reported lower cognitive and somatic anxiety during the anxiety provoking situation, and (c) their heart rate recovered faster, in contrast to both their baseline heart rate and the control subjects' heart rate, from the stress episode. These results demonstrate that a fitness-oriented exercise program has anxiolytic properties. They also provide a primary evidence that overt behavioral anxiety, as opposed to the usually measured self-reported anxiety, may be affected by exercise.