Lifestyle modifications

NUTRITION

  • A low FODMAP diet may reduce symptoms, particularly fibromyalgia patients with irritable bowel syndrome (7)
  • Vitamin D: Limited evidence suggests that supplementation or adequate levels may reduce symptoms (5)
  • There is some evidence that a plant based diet may reduce symptoms of fibromyalgia (6)

PHYSICAL ACTIVITY

  • Regular physical activity / exercise is the only therapy with a strong recommendation (2)
  • Activities that combine exercise with relaxation training is effective (1)
  • Both aerobic exercise and resistance training are associated with improved pain and physical function (2)
  • Both land based and water based exercise are effective (3)
  • Pain may increase in the beginning of an exercise program. Thus, it is important to motivate the patient to continue the program, preferably light to moderate intensity 2-3 times per week (3)
  • Regular aerobic exercise may possibly also reduce fatigue and stiffness (4)

STRESS

  • Stress may increase fibromyalgia symptoms. Thus learning stress management is useful (8)

SLEEP

  • Most people with fibromyalgia have non restorative sleep (9)
  • Maintain good sleep hygiene (8)
  • Low quality evidence shows that among people with fibromyalgia cognitive behavior therapy for insomnia (CBT-I) improves sleep quality, pain, anxiety, depression, but not sleep efficiency compared to other non-pharmacological treatments (10)

References

1) https://bestpractice.bmj.com/topics/en-gb/187/treatment-algorithm

2) Macfarlane, Gary J., et al. “EULAR revised recommendations for the management of fibromyalgia.” Annals of the rheumatic diseases 76.2 (2017): 318-328. (Link)

3) Häuser, Winfried, et al. “Efficacy of different types of aerobic  exercise in fibromyalgia syndrome: a systematic review and meta-analysis  of randomised controlled trials.” Arthritis research & therapy 12.3 (2010): 1-14. (Link)

4) Bidonde, Julia, et al. “Aerobic exercise training for adults with fibromyalgia.” Cochrane Database of Systematic Reviews 6 (2017). (Link)

5) https://www.ingentaconnect.com/content/ben/crr/2022/00000018/00000004/art00006

6) https://www.mdpi.com/1660-4601/18/9/4955

7) https://www.tandfonline.com/doi/full/10.1080/07853890.2018.1564360

8) https://www.uptodate.com/contents/initial-treatment-of-fibromyalgia-in-adults

9) https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-fibromyalgia-in-adults

10) https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1954706

Resources

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

​Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

​Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

​Evidence based on observational / cohort studies is written in CURSIVE font