Samenvatting

Main question:
The main question of this project was: "Which treatment programmes of graded aerobic exercise result in improved Quality of Life in patients diagnosed with the fibromyalgia syndrome based on evidence based literature?"
Background:
The fibromyalgia syndrome is one of the many chronic musculoskeletal disorders seen today. In Norway the number of patients receiving the diagnosis of fibromyalgia is growing Patients with fibromyalgia often have a reduced Quality of Life (QoL). It is thought that this can be a reason for why they no longer are able to work. Not being able to work can also result in a reduced QoL.
In Norway fibromyalgia patients have to pay for the treatment themselves. As the condition is chronic this means high treatment costs for the patient.
The aim of this report was to find which existing graded aerobic exercise programmes proved to be beneficial for improving the QoL in patients diagnosed with the fibromyalgia syndrome. The attention was also drawn towards finding treatment programmes that were cost-effective for fibromyalgia patients.
Method:
PubMed, Doconline, Cochrane Library and the Picarta databases were searched. Full text articles were located and cross-reference checking was done, resulting in additional fulltext articles. Articles were then analysed according to in- and exclusion criteria stated in the project plan (appendix 1). Articles fulfilling these criteria were analysed for methodological quality using the PEDro scale. Finally relevant data was extracted from the included articles, according to a self-designed data extraction checklist. A description of the characteristics of the graded aerobic exercise programmes was presented. Based on contradictory findings between programmes a comparison was conducted regarding the effects on QoL. These effects on QoL were found by comparing scores of six QoL questionnaires.
Results:
Seventy-five percent of programmes including a combination of land-based exercise and hydrotherapy and of programmes including patient education achieved improved QoL.
Sixty percent of programmes containing several activities and fifty-seven percent of exercise programmes including hydrotherapy achieved significant effects on QoL. Fifty percent of long-term programmes and of programmes including home exercises had effects. Supervised exercise programmes performed in groups resulted in improved QoL. An unsupervised individual exercise programme resulted in no improvements in QoL.
Conclusion:
If patients comply with the treatment plan, graded aerobic exercise seems to be beneficial in improving QoL, as long as the programme has certain characteristics.
Most significant effects on QoL were found in programmes with education, in several activity type programmes and in programmes including hydrotherapy. Especially the combination of hydrotherapy and land-based exercise was beneficial.
Long-term programmes and programmes including home exercise also had significant effects. Programmes with supervision and programmes performed in groups had beneficial effects on QoL.
There was a problem of a high drop out rate in all the included exercise programmes. Supervision of the exercise programmes and exercising in groups was found to stimulate compliance.
A graded aerobic exercise programme may contribute to reduce the costs of physiotherapy treatment for fibromyalgia patients.