EFFECTIVENESS OF EXERCISE IN THE MANAGEMENT OF FATIGUE AND SLEEP QUALITY IN FIBROMYALGIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background Non-pharmacological interventions are the mainstay of treatment for fibromyalgia, however, current evidence-based guidelines report that the only therapy supported by ‘strong for’ evidence is exercise intervention for pain in fibromyalgia [1]. While increased fatigue and poor sleep quality are among the most burdensome symptoms in fibromyalgia, there remains limited evidence for the effectiveness of exercise in the management of these symptoms [2,3] Objectives To determine the effectiveness of exercise in the management of fatigue and sleep quality in fibromyalgia. Methods A systematic search was conducted using PubMed and Web of Science in October 2018 (Prospero Registration No. CRD42018118005). Eligible studies were randomised controlled trials (RCT) including adults with fibromyalgia (population), who received exercise (intervention) compared to usual care (comparator). Outcomes of interest were fatigue and/or sleep quality. No restrictions were applied for language nor for publication date. Random effects meta-analyses were conducted. The Cochrane Collaboration’s tool was used for assessing risk of bias in the included studies. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results Twenty RCTs were included, 17 included measures of fatigue (n=1003) and 12 measures of sleep quality (n=731). In comparison to usual care, exercise had beneficial effects on fatigue (Figure 1, P<0.001) but not on sleep quality (Figure 2, P=0.06). The most beneficial interventions for fatigue and improving sleep quality, were those in which fatigue was the primary outcome and those based on body-mind interventions, respectively (both, P<0.001). A moderate risk of bias was present in most of the included studies. • Download figure • Open in new tab • Download powerpoint Figure 1 Pooled effects of randomised controlled trials analysing the effectiveness of physical exercise on reducing fatigue in people with fibromyalgia. • Download figure • Open in new tab • Download powerpoint Figure 2 Pooled effects of randomised controlled trials analysing the effectiveness of physical exercise on enhancing sleep quality in people with fibromyalgia. Conclusion According to the GRADE framework, this review provides low-to-moderate quality evidence that exercise is moderately effective for improving fatigue, and moderate evidence of no/meaningless effects of exercise to improve sleep quality. Further high quality RCTs are required to determine the effectiveness of exercise on fatigue, and in particular, sleep quality in fibromyalgia References [1] Macfarlane GJ, et al. Ann Rheum Dis2017;76:318–28. Doi:10.1136/annrheumdis-2016-209724 [2] Bidonde J, et al. Cochrane Database Syst Rev 2017;2017. Jun 21;6:CD012700 doi:10.1002/14651858.CD012700 [3] Busch AJ, et al. Cochrane database Syst Rev 2013;:CD010884. doi:10.1002/14651858.CD010884 Analyses were conducted using a random effects model. CI, Confidence Interval; df, degrees of freedom; Std, Standardised; SD, Standard Deviation; IV, Inverse Variance; Co-, Co-intervention (Photo, phototherapy; edu, education); C, Cardiorespiratory exercise; F, flexibility exercise; S, Strength training; TC, Tai Chi; QG, Quigong; Y, Yoga; L- and W-B, land- and water-based exercise, respectively. Acknowledgement This study was funded by the Health and Social Care Public Health Agency, Northern Ireland (STL/5268/16) and the Spanish Ministry of Economy and Competitiveness (BES-2014-067612) Disclosure of Interests None declared