Due to patients’ complaints of pain and fatigue, finding the correct dosage of exercise and ensuring adherence can be clinically challenging. Many patients will benefit from close monitoring and supervision from healthcare professionals, such as physical therapists.
Strengthening programs should begin with lower resistance than age-predicted norms.1 Busch et al recommend the intensity and duration of exercise sessions should be reduced when significant post-exertion pain or fatigue is experienced and the intensity increased by 10% after two weeks of exercise without exacerbating symptoms.1
To facilitate adherence, exercise of the patient’s choice is encouraged and should be adjusted according to the individual’s ability. This may be an aerobic, strengthening, water, home-based or group program, depending on availability to an individual patient.4 Self-efficacy is important for adherence and may be facilitated in group exercise sessions to provide support and motivation.
Aquatic Physical Therapy
Aquatic therapy is a commonly used treatment technique for individuals with FMS. A systematic review by Lima et al found that aquatic physical therapy resulted in an improvement in quality of life, physical function and stiffness when compared with no treatment after 20 weeks. However, when comparing aquatic vs. land physical therapy, there were no significant differences noted in pain or depression.10
When prescribing an aquatic therapy program, a number of different factors must be included to achieve the best results for the patient. The temperature should not exceed 30ºC when performing aerobic activities, such as running in water.10 However, because warm water has many favorable effects for individuals with FMS, exercises, such as stretching, mobility and strengthening, that do not have a strong aerobic component that would result in the patient overheating, should be performed at greater than 32ºC.
Busch et al concluded that although land- and water-based exercises may have similar outcomes based on some measures, exercising in water may be preferable to land-based exercise for individuals who are severely deconditioned or who have high levels of pain.1
Multimodal Approach
To maximize outcomes, a multimodal approach tailored to each individual patient’s needs should be used. Physical therapy for patients with FMS should include education, aerobic exercise and strengthening exercise.9 Although not as strongly supported in the literature, patients with FMS may also benefit from manual therapy techniques, such as joint, soft tissue and myofascial mobilization.9,11
Physical therapy interventions should be individualized to each patient’s needs, as determined by a thorough history and clinical examination. Nijs et al also recommend that patients be educated about the nature of their symptoms and illness and that education be used to introduce and implement various other treatment options, such as activity management and stress management.11