ORIGINAL ARTICLE  SPORT INJURIES AND REHABILITATION 

The Journal of Sports Medicine and Physical Fitness 2019 May;59(5):828-38

DOI: 10.23736/S0022-4707.18.08897-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Therapeutic validity of exercise interventions in the management of fibromyalgia

Inmaculada C. ÁLVAREZ-GALLARDO ^{1, 2} ✉, Julia BIDONDE ^{3, 4}, Angela BUSCH ³, Marie WESTBY ⁵, Glen P. KENNY ⁶, Manuel DELGADO-FERNÁNDEZ ², Ana CARBONELL-BAEZA ¹, Prinon RAHMAN ⁷, Gino DE ANGELIS ⁸, Lucie BROSSEAU ⁸

¹ Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain; ² Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain; ³ School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada; ⁴ Department of Health Technology Assessment at the Norwegian Institute of Public Health, Oslo, Norway; ⁵ Mary Pack Arthritis Program, Vancouver Coastal Health, Vancouver, BC, Canada; ⁶ Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; ⁷ Department of Community Health and Epidemiology, Dalhousie University, Halifax, NC, Canada; ⁸ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada

BACKGROUND: This study aimed to evaluate the therapeutic validity of exercise interventions included in a previous umbrella systematic review of high-quality randomized controlled trials (RCTs) in the management of fibromyalgia and to explore whether exercise interventions with high therapeutic validity and that meet the 2013 American College of Sports Medicine (ACSM) guidelines are positively associated with greater pain relief.
METHODS: Therapeutic validity was evaluated based on the CONsensus on Therapeutic Exercise and Training (CONTENT) Scale, in high methodological quality RCTs found in the nine systematic reviews of a previous umbrella review on exercise interventions in the management of fibromyalgia. Additionally, adherence to the 2013 ACSM exercise recommendations for fibromyalgia was analyzed. The effect size for pain relief after the exercise programs was also considered.
RESULTS: The CONTENT mean total score was 4.42 out of 9, demonstrating generally low therapeutic validity of the 28 included RCTs. There was poor concordance between therapeutic validity and pain relief (Kappa values ranging between -0.6 to 0.57). Kappa statistic results showed poor concordance (k=0.01) between statistically significant (P<0.05) pain relief values and adherence to the 2013 ACSM exercise recommendations.
CONCLUSIONS: The therapeutic validity of exercise intervention programs in fibromyalgia is low. This is mainly due to incomplete descriptions of exercise interventions and adherence. Poor concordance is found between high therapeutic validity and adherence to the ACSM exercise recommendations with pain relief. Improved standardized reporting is recommended to identify optimal exercise prescription for fibromyalgia.

KEY WORDS: Pain - Exercise - Health planning guidelines - Randomized controlled trial