Dosagem do exercício de resistência na fibromialgia: guia prático clínico baseado em evidências

Abstract

Introduction: Fibromyalgia refers to a chronic, generalized, heterogeneous and complex painful condition, which although pain is the dominant symptom, other symptoms such as fatigue, sleep disorders, among others, have an important influence on the quality of life. Currently there is no cure for fibromyalgia, treatment is symptomatic and should concentrate on non-pharmacological therapies. According to the most recent guidelines, the only strong recommendation for the treatment of Fibromyalgia is exercise, particularly due to its effect on pain, physical function and well-being, accessibility, relatively low cost and minimal adverse effects. Several scientific studies have examined the effect of physical activity in people with fibromyalgia, but the studies vary according to the treatment protocol, such as frequency, intensity and duration. Objective: To verify the strength of resistance training (intensity, number of sets and repetitions, weekly frequency, duration of treatment in weeks), based on scientific evidence, is effective for pain improvement in women with fibromyalgia. Method: This is a clinical Practical Guide (GPC) based on randomized clinical trials (ECRs) included in a systematic review by Busch et al. and published in the Cochrane Library in 2013 with the title "Resistance Exercise Training for fibromyalgia" and in its update from 2013 to 2018 using the same search strategies, in the following databases: Cochrane Database of Systematic Reviews Physiotherapy Evidance Database (PEDro); Pubmed Embase, Cinahl with addition of the LILACS database. Results: For the exercises performed in the intensity between 40 to 80% of 1RM, there was a statistically significant improvement for the pain outcomes (SMD-0.52 [95% CI [-0.89,-0.15]), I2 = 51% (five studies, 310 patients) with one to two series (SMD-0.42 [95% CI [- 0.71,-0.13]), I2 = 26% (four studies, 294 patients) between four and 12 repetitions (SMD-0.56 [95% CI [-1.07,-0.04]), I2 = 68% (five studies, 206 patients) or five to 20 repetitions (SMD-0.61 [95% CI [-1.17,-0.06]), I2 = 73% (Three studies, 256 patients), Performed twice a week (SMD-0.57 [95% CI [-0.88,-0.26]), I2 = 60% (Nine studies, 488 patients), for eight to 12 weeks (SMD-0.74 [95% CI [-1.24,-0.25]), I2 = 48% (four studies, 140 patients) compared to a control group. Products developed: a GPC (article) and a flyer were developed as a product of this master's degree. Conclusions: This GPC identified and summarized information from nine ECRs and found, based on the analysis of the studies included, that for women with fibromyalgia a resistance training program performed twice a week, for eight to 12 weeks, with Intensity of 40 to 80%, with one to two series of four to 20 repetitions leads to improvement in pain.