{"id":41645,"date":"2018-03-21T21:55:27","date_gmt":"2018-03-21T20:55:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41645"},"modified":"2018-03-28T10:38:06","modified_gmt":"2018-03-28T09:38:06","slug":"chenchen-wang-time-to-rethink-exercise-for-fibromyalgia-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/03\/21\/chenchen-wang-time-to-rethink-exercise-for-fibromyalgia-care\/","title":{"rendered":"Chenchen Wang: Time to rethink exercise for fibromyalgia care"},"content":{"rendered":"

It’s time to explore new approaches to provide the best care for patients with chronic pain conditions<\/p>\n

\"\"<\/strong><\/em><\/p>\n

In 2010, the New York Times<\/em><\/a>\u00a0<\/span>published a story<\/span>\u00a0about Mary, a participant in a randomi<\/span>sed trial my team conducted w<\/span>hich\u00a0investigat<\/span>ed\u00a0the efficacy of <\/span>tai <\/span>chi for fibromyalgia. Mary <\/span>is just\u00a0one of the many patients with chronic musculoskeletal pain who we see in our rheumatology and primary care clinics every day. Like those patients, Mary complained that it \u201churt so much just to put my arms over my head,\u201d \u201csleeping was difficult,\u201d \u201cI couldn\u2019t walk half a mile,\u201d and said that she felt no motivation or pleasure <\/span>in\u00a0life anymo<\/span>re.\u00a0Patients like Mary have often tried <\/span>different\u00a0<\/span>drugs for pain, antidepressants, physical therapy, and other approaches, and find that <\/span>nothing works\u00a0for them. Given the large and growing global burden of chronic pain, finding safe, effective approaches for <\/span>its management is an urgent priority. \u00a0<\/span><\/span><\/p>\n

Chronic widespread pain is a complex biopsychosocial medical condition that is associated with substantial mental health comorbidities. Tai <\/span>chi<\/span>\u00a0integrates physical, psychosocial, and behavioural elements, and may be especially suited to <\/span>tackling both the psychological and somatic symptoms associated with chronic pain. <\/span><\/p>\n

A series of studies on <\/span>tai <\/span>chi for chronic rheumatic conditions from our team[1-8]<\/sup>\u00a0found that the practice has short term therapeutic benefits for pain relief and wellbeing. Several<\/span>\u00a0smaller, shorter efficacy trials <\/span>have found similar short term benefits. In our most recent study, published in <\/a><\/span>The BMJ<\/em>,<\/span>\u00a0we compared the effectiveness of <\/span>tai <\/span>chi <\/span>with aerobic exercise, which is a standard care, non-drug treatment for fibromyalgia.<\/span>\u00a0<\/span>The study showed that <\/span>tai <\/span>chi is <\/span>as or more effective than aerobic exercise, and that longer duration of treatment provides greater effect. We also found that these therapeutic benefits were consistent across a diverse group of patients, regardless of the instructor. This suggests that the intervention can be delivered in a standardi<\/span>sed manner by appropriately trained instructors. Therefore, <\/span>tai <\/span>chi may be applied in a variety of settings for a <\/span>range\u00a0of patients. \u00a0<\/span><\/p>\n

Despite the well<\/span>\u00a0established benefits of aerobic exercise as a<\/span>\u00a0<\/span>core<\/span>\u00a0<\/span>standard treatment <\/span>for fibromyalgia, patients<\/span>\u00a0in our trial had difficulty adhering to the <\/span>aerobic exercise program<\/span>me<\/span>. <\/span>This may not be surprising<\/span>\u2014many patients with fibromyalgia <\/span>find\u00a0performing and adhering to exercise programmes hard.<\/span>\u00a0<\/span>Complaints such as\u00a0\u201cth<\/span>e floor is too hard,\u201d \u201cI cannot stand this,\u201d \u201cI\u2019m too tired,\u201d or \u201cI\u2019m in too much pain\u201d were common. Despite encouragement by study staff, many participants<\/span>\u00a0<\/span>missed classes, and <\/span>attendance was lower than in the <\/span>tai <\/span>chi group. In contrast, people from the <\/span>tai <\/span>chi group continue to call our office looking for opportunities for <\/span>tai <\/span>chi training <\/span>now that the study has ended. What we found suggests that patients may be more likely to enjoy, manage, and continue to practise tai chi, perhaps because it involves gentle, low impact movements with minimal side effects.<\/span><\/span><\/p>\n

It may be time to rethink what type of exercise is most effective for patients with fibromyalgia. More importantly, what types or combinations of exercise would patients <\/span>embrace<\/span>\u00a0in the long term?<\/span>\u00a0The public health <\/span>problem of chronic pain<\/span>\u00a0<\/span>calls for an <\/span>\u201call hands on deck<\/span>\u201d\u00a0approach to <\/span>give patients feasible therapeutic options for the management of fibromyalgia. <\/span>It is time<\/span>, therefore, for physicians to explore new approaches and rethink their strategies in order to provide the best care for patients with chronic pain conditions. <\/span>\u00a0<\/span><\/p>\n

Chenchen Wang<\/strong> is a professor of medicine at Tufts University School of Medicine and director of the Center for Complementary and Integrative Medicine in the Division of Rheumatology at Tufts Medical Center, Boston, US.<\/em><\/p>\n

Competing interests:<\/strong> None declared.<\/em><\/p>\n

In memory of (my beloved husband), Dr. Carl O. Bozler, the MIT Lifetime Achievement Award scientist for his (endless love), inspirational encouragement, and infinite support on this scientific research.<\/em><\/p>\n

References<\/strong><\/p>\n

    \n
  1. Wang C, Schmid CH, Iversen MD, <\/span>et al<\/span>. Comparative effectiveness of tai chi versus physical therapy for knee osteoarthritis: a randomized trial. <\/span>Annals of Internal Medicine<\/span><\/em>. 2016;165(2):77-86.<\/span>\u00a0 <\/span><\/li>\n
  2. Wang C. Role of <\/span>tai <\/span>chi in the treatment of rheumatologic diseases. <\/span>Current Rheumatology Reports<\/span><\/em>.<\/span>\u00a02012;14:598-603. <\/span><\/li>\n
  3. Wang C. Tai <\/span>chi and rheumatic diseases. <\/span>Rheumatic Disease Clinics of North America<\/span><\/em>.<\/span>\u00a02011;37:19-32. <\/span><\/li>\n
  4. Wang C, Schmid<\/span>\u00a0<\/span>C, Kalish R, <\/span>et al. A randomized trial of <\/span>tai <\/span>chi for fibromyalgia. <\/span>New England Journal of Medicine<\/span><\/em>. <\/span>2010;363:743-54<\/span>. <\/span><\/li>\n
  5. Wang C, Schmid C, Hibberd P, <\/span>et al. Tai <\/span>chi is effective in treating knee osteoarthritis: a randomized controlled trial. <\/span>Arthritis & Rheum<\/span><\/em>.<\/span>\u00a02009;61:1545-53. <\/span><\/li>\n
  6. Wang C. Tai <\/span>chi improves pain and functional status in adults with rheumatoid arthritis: results of a pilot single-blinded randomized controlled trial. <\/span>Medicine and Sport Science<\/em>.<\/span>\u00a02008;52;218-29. <\/span><\/li>\n
  7. Wang C, Roubenoff\u00a0 R, Lau J, <\/span>et al. Effect of <\/span>tai <\/span>chi in adults with rheumatoid arthritis. <\/span>Rheumatology<\/em>.<\/span>\u00a0 2005;44 685-7. <\/span><\/li>\n
  8. Wang C, Collet J, Lau J. The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review. <\/span>JAMA Internal Medicine<\/em>.<\/span>\u00a0<\/span>2004;164:493-501.<\/span>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/li>\n<\/ol>\n

    \n","protected":false},"excerpt":{"rendered":"

    It’s time to explore new approaches to provide the best care for patients with chronic pain conditions […]<\/p>\n

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