231. The Effectiveness of Exercise in the Management of Fatigue and Sleep Dysfunction in Fibromyalgia Syndrome: A Systematic Review

Abstract

Background: Objective: To evaluate the effectiveness of exercise in the management of fatigue and sleep dysfunction in fibromyalgia syndrome (FMS) and to identify the type, intensity, frequency and duration of exercise therapy most effective in FMS. Methods: This review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with the PROSPERO database (CRD 42013004439). Ten electronic databases were searched using a Cochrane style search strategy. Only randomized controlled trials published in English, French or Spanish were included in this review. All studies must also have included an exercise component which had to comprise at least 50% of the intervention. The main outcome of interest was fatigue; the secondary outcome was sleep dysfunction. Methodological quality was assessed using the van Tulder scale and the Cochrane Risk of Bias tool. Studies were deemed high quality if they scored ≥6/12 on the van Tulder scale and major risks of bias were: inadequate randomization, inadequately concealed treatment allocation and non-blinding of outcome assessors. Data were summarized qualitatively using a best evidence synthesis and were possible effect sizes were calculated using Cohen's d. Results: Thirty five studies were included in the review of which 20 were high quality scoring, ≥6 on the van Tulder scale. Nine of these high quality studies were also deemed to have a low risk of bias. Six of these high quality / low risk of bias studies reported statistically significant outcomes for fatigue and three reported significant outcomes for sleep dysfunction. Positive studies had small to large effect sizes (0.1-0.9). Exercise interventions that improved fatigue and sleep were of moderate intensity (e.g. pool exercises, yoga, walking), delivered more than once per week for 60mins, for a mean duration of 10 weeks. Dropout rates from the include studies in the review were low ranging from 10-19%. Conclusion: Exercise interventions can improve fatigue and sleep dysfunction in FMS, however, methodological quality remains an issue for many studies and no study reported fatigue as the primary outcome. Physical activity interventions for sleep dysfunction are rarely studied.