8) Results from this study relate a moderate quality evidence that aerobic-only exercise training at recommended intensity levels produces positive effects "global well-being (SMD 0.44, 95% confidence interval (CI 0.13 to 0.75) and physical function (SMD 0.68, 95% CI 0.41 to 0.95) and possibly on pain (SMD 0.94, 95% CI -0.15 to 2.03) and tender points (SMD 0.26, 95% CI -0.28 to 0.79)." Results noted that flexibility and strength and flexibility remain under assessed. (Busch, Barber, Overend, Peloso, and Schachter, 2007, pp. 11-13)

According to criteria Melnyk Fineout-Overholt (2005) present, this study is a Level II study. From the Cochrane review, the following relates what research notes regarding the effect of exercise for FMS:

moderate intensity aerobic training for 12 weeks may improve overall well-being slightly and physical function.; moderate intensity aerobic exercise probably leads to little or no difference in pain or tender points.

A strength training for 12 weeks may result in large reductions in pain, tender points and depression, and large improvement in overall well-being but may not lead to any difference in physical function.

A the exercises programs that were studied were safe for most. The intensity of aerobic exercise training should be increased slowly aiming for a moderate level. If exercisers experience increased symptoms, they should cut back until symptoms improve. If in doubt about adverse effects, they should check with a health care professional.

A it is not known whether exercise training for more than 12 weeks improves other symptoms such as fatigue, stiffness or poor sleep.

It is not known whether flexibility training, programs combining types of exercise, and programs combining exercise with nonexercise strategies improve the symptoms of fibromyalgia. (Busch, Barber, Overend, Peloso, and Schachter, 2007, p. 2)

The primary results of the review by Busch, Barber, Overend, Peloso, and Schachter (2007, pp. 13-14) includes the following:

Moderate quality evidence exists that aerobic-only exercise training at recommended intensity levels has medium-size positive effects on pain, small to medium-sized positive effects on global outcome measures and medium-sized positive effects on measures of physical function; the effect of such exercise on tender points is less certain but we cannot rule out the possibility that aerobic exercise has a large positive effect;

Strength and flexibility remain under-evaluated as exercise prescriptions for people with FMS;

Despite the increasing number of studies investigating the effect of combination treatments with exercise, this question has also received inadequate study, principally because there is underutilization of appropriate research designs;

There is limited evidence on a variety of other outcomes including stiffness, fatigue, and depression;

The analysis of percentage change reinforced the results of metaanalysis. In aerobics-only interventions, clinically significant improvements were found sporadically in six variables: depression, tender points, global well-being, physical function, self-efficacy and symptoms. (Busch, Barber, Overend, Peloso, and Schachter, 2007, pp. 13-14)

One particular strength noted in this study links to the reported "gold" level evidence (www.cochranemsk.org) thatwhen FM patients receive directed support to complete regular aerobic exercise training; the exercise efforts prove to produce positive effects on their physical capacity and FMS symptoms. (Busch, Barber, Overend, Peloso, and Schachter, 2007, p. 16) Several limitations included the fact that as a number of people with FMS experienced difficulty continuing an exercise program, no specific plans to ensure individuals exercise regularly were measured in these studies.

The researchers state that along with anticipated positive results from supervised regular aerobic exercise training, strength training may additionally contribute to benefits on numerous FMS symptoms.

Along with more research on long-term benefit of exercise for FMS, albeit, Busch, Barber, Overend, Peloso, and Schachter (2007, p. 17) recommend additional study relating to muscle strengthening and flexibility be conducted.

Study

During the second study reviewed, "A randomized clinical trial of an individualized home-based exercise programme (sic) for women with fibromyalgia, in their randomized clinical trial of an individualized home-based exercise program for women with fibromyalgia, conducted by Costal, Abrahamowicz, Lowensteyn, Bernatsky, Dritsa1, Fitzcharles, and Dobki (2005, p. 1422), the authors purposed to determine "the efficacy of a 12-week individualized home-based exercise program on physical functioning, pain severity and psychological distress for women with fibromyalgia (FM)." The research design utilized for this study consisted of the assessment of participants constituting a sample of seventy-nine women with a primary diagnosis of FM, "randomized to a 12-week individualized home-based moderate-intensity exercise programme (sic) or to a usual care control group." (Costal et al., 2005, p. 1422)

Researchers selected participants from two sources:

hospital or community rheumatologists, either directly or by invitation letters, and newspaper ads

Criteria for exclusion of participants...

1422) to measure functional capacity, participants completed a "Fibromyalgia Impact Questionnaire" denoting their pain severity and psychological distress. For the procedure, researchers measured outcomes at initial study entry, at the end of the 12-week intervention, and again at three and nine months following completion of the intervention. A rheumatologist examined each consenting subject to confirm diagnosis of FM at study entry. Later, at nine months post-treatment, the same rheumatologist (blinded to randomization status) re-examined the participants. "Eligible participants completed a graded maximal exercise stress test, using the Bruce protocol [19] prior to randomization. This test was used to screen participants, determine baseline fitness and individualize the exercise prescription for participants assigned to the exercise group." Researchers evaluated participants' fitness via time on test, along with maximal metabolic equivalents (METs) capacity.
Results for this study indicate that following treatment, based on the intention-to-treat analyses, the participants who more functionally disabled in the exercise group at study entry experienced a significant improvement in functional capacity at three and nine months for participants. Outcomes for the female FM participants, compared with the control group at the end of the 12-week intervention, and at the three and none month intervals, after the intervention ended, noted statistically significant improvements in participants' upper body pain at post-treatment. The group of study participants, albeit, did not reveal any statistically significant differences regarding lower body pain and/or psychological distress. (Costal et al., 2005, p. 1422)

The key messages from this study, according to Costal et al. (2005, p. 1427) purport:

Home-based moderate intensity exercise improves upper body pain in womenwith fibromyalgia after 12-weeks and overall health status within 6 months of initiation.

The benefits observed were maintained at 9 months post-treatment.

The authors note that, as the primary outcome measures were obtained through participants' self reports, the occurrence of effects relating to subject expectancy cannot be ruled out. In addition, his study y did not include an attention control group.

This researcher purports that the fact the principal outcome measures were acquired through participants' self reports simultaneously serves as a strength and weakness. (Costal et al., 2005, p. 1426)

Study

The purpose of the prospective study, a series of randomized clinical trials (RCT), "Adherence During an Individualized Home-Based 12-Week Exercise Program in Women with Fibromyalgia," by Dobkin, Costa, Abrahamowicl, Dritsa, Du Rger, Fitzcharles, and Lowensteyn (2006) was to explore predictors for adherence to stretching and aerobic exercises in women with fibromyalgia. This study specifically aimed to:

identify predictors of uptake of stretching and aerobic exercises, and elucidate longitudinal changes in exercise, taking into account participants' baseline characteristics.

The research design included the provision of an individualized home-based program for each of the participants. For the procedure utilized in this study, 39 women (average age 49.2 years) recorded their progress in exercise diaries for 12 weeks. Participants recruited included women matching American College of Rheumatology criteria for a diagnosis of primary FM. Rheumatologists invited participants through letters, and they were also solicited through individuals working with FM patients followed at a hospital rheumatology clinic and/or community rheumatology practice, as well as through newspaper ads. Exclusion criteria for this study included (Dobkin, et al., 2006):

Concomitant diseases that precluded participation in an exercise program, contraindication to exercise identified by the examining physician, recent change in medication (prior 2 weeks), and regular participation in moderate intensity exercise (i.e., 3.0-6.0 MET, where one MET represents the metabolic activity of an individual at rest: 3.5 ml oxygen consumed per kg body mass per min, or about 1 kcal/kg/h) for at least 30 minutes, 3 times a week at the time of study entry. (Dobkin, et al., 2006)

Participants filled out an in-session questionnaire each weekly reporting whether they practiced respective interventions three or more times per week (yes/no). At the end of six weeks, researchers calculated a summary score for the consecutive weeks to determine adherence to the program. (Dobkin, et al., 2006)

Researchers reported each of the participant's pain intensity at baseline and then weekly during the 12-week training phase. Each of the participants related her pain intensity each week "on 100 mm VAS 24 in 6 areas: neck and shoulders, chest, upper/lower back, arms, buttocks, aid legs. End descriptors were 0 = no pain to 100 = severe pain," (Dobkin, et al., 2006) with the higher values denoting higher levels of pain. Researchers summed scores…