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Are There Interindividual Differences in Anxiety as a Result of Aerobic Exercise Training in Adults With Fibromyalgia? An Ancillary Meta-analysis of Randomized Controlled Trials

  • George A. Kelley
    Correspondence
    Corresponding author George A. Kelley, DA, FACSM, Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9190, Morgantown, WV 26506-9190.
    Affiliations
    Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV
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  • Kristi S. Kelley
    Affiliations
    Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV
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  • Leigh F. Callahan
    Affiliations
    Department of Social Medicine, University of North Carolina, Chapel Hill, NC

    Department of Orthopedics, University of North Carolina, Chapel Hill, NC

    Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
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Published:January 16, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.019

      Abstract

      Objective

      To determine whether true interindividual response differences (IIRD) exist with respect to changes in anxiety because of aerobic exercise training in adults with fibromyalgia (FM).

      Data Sources

      Data from a previous meta-analytical database of randomized controlled trials of exercise in adults with arthritis and other rheumatic diseases.

      Study Selection

      Randomized controlled trials limited to aerobic exercise training on anxiety in adults 18 years or older with FM were included.

      Data Extraction

      Change outcome SDs treated as point estimates for anxiety were used to calculate true IIRD from each study. In addition, treatment effect data were extracted.

      Data Synthesis

      The inverse variance heterogeneity model was used to pool all results. For the 5 studies and 321 participants in which results were pooled, statistically significant treatment effect reductions in anxiety were observed (mean, −0.77 points, 95% CI, −1.25 to −0.77). However, no significant IIRD were found (mean, 0.6 points, 95% CI, −1.2 to 1.5). The 95% prediction interval for true IIRD in a future study was −1.7 to 0.8. The percent chance, ie, probability, of a clinically meaningful difference in variability, was 61.5% (only possibly clinically important).

      Conclusions

      The results of the current study suggest that aerobic exercise is associated with reductions in anxiety among adults with fibromyalgia. However, there is currently a lack of convincing evidence to support the notion that true IIRD exist. Therefore, a search for potential mediators and moderators associated with aerobic exercise and changes in anxiety among adults with FM may not be warranted. However, additional research is needed before any true level of certainty can be established. This includes (1) the assessment of IIRD in future randomized controlled trials, (2) randomized controlled trials of longer duration, and (3) an increase in the proportion of men included in randomized controlled trials.

      Keywords

      List of abbreviations:

      FM (fibromyalgia), GRADE (Grading of Recommendations Assessment, Development, and Evaluation), IIRD (interindividual response difference), MCID (minimal clinically important difference), NNT (number needed to treat), PI (prediction interval)
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      References

        • Galvez-Sánchez CM
        • Reyes Del Paso GA
        Diagnostic criteria for fibromyalgia: critical review and future perspectives.
        J Clin Med. 2020; 9: 1219
        • Marques AP
        • Santo ASDE
        • Berssaneti AA
        • Matsutani LA
        • Yuan SLK.
        Prevalence of fibromyalgia: literature review update.
        Rev Bras Reumatol. 2017; 57: 356-363
        • Schaefer C
        • Mann R
        • Masters ET
        • et al.
        The comparative burden of chronic widespread pain and fibromyalgia in the United States.
        Pain Pract. 2016; 16: 565-579
        • Fietta P
        • Fietta P
        • Manganelli P.
        Fibromyalgia and psychiatric disorders.
        Acta Biomedica. 2007; 78: 88-95
        • Kelley GA
        • Kelley KS
        • Callahan LF.
        Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a systematic review with meta-analysis of randomised controlled trials.
        BMJ Open. 2018; 8: 18
      1. Physical activity guidelines advisory committee report, 2018, U.S. Department of Health and Human Services; Washington (DC).

        • Bidonde J
        • Busch AJ
        • Schachter CL
        • et al.
        Aerobic exercise training for adults with fibromyalgia.
        Cochrane Database Syst Rev. 2017; 6CD012700
      2. Arthritis Foundation. Medications for treating fibromyalgia symptoms. Available at: https://www.arthritis.org/diseases/more-about/medications-for-treating-fibromyalgia-symptoms. Accessed October 30, 2021.

        • Alrasheed M
        • Hincapie AL
        • Guo JJ.
        Drug expenditure, price, and utilization in the U.S. Medicaid: a trend analysis for SSRI and SNRI antidepressants from 1991 to 2018.
        J Ment Health Policy Econ. 2021; 24: 3-11
        • Jameson JL
        • Longo DL.
        Precision medicine–personalized, problematic, and promising.
        N Engl J Med. 2015; 372: 2229-2234
        • Tomasi J
        • Lisoway AJ
        • Zai CC
        • et al.
        Towards precision medicine in generalized anxiety disorder: review of genetics and pharmaco(epi)genetics.
        J Psychiatr Res. 2019; 119: 33-47
        • Atkinson G
        • Batterham AM.
        True and false interindividual differences in the physiological response to an intervention.
        Exp Physiol. 2015; 100: 577-588
        • Hecksteden A
        • Kraushaar J
        • Scharhag-Rosenberger F
        • Theisen D
        • Senn S
        • Meyer T.
        Individual response to exercise training - a statistical perspective.
        J Appl Physiol. 2015; 118: 1450-1459
        • Kelley GA
        • Kelley KS
        • Callahan LF.
        Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a protocol for a systematic review and meta-analysis of randomised controlled trials.
        BMJ Open. 2017; 7e014957
        • Baptista AS
        • Villela AL
        • Jones A
        • Natour J.
        Effectiveness of dance in patients with fibromyalgia: a randomized, single-blind, controlled study.
        Clin Exp Rheumatol. 2012; 30: 18-23
        • Beltran R.
        The effects of a supervised group aerobic exercise program and a chronobiologicary oriented treatment protocol on symptomotatogy and mood in women with fibromyalgia [dissertation].
        Alliant International University, Alhambra2003
        • Gowans SE
        • deHueck A
        • Voss S
        • Silaj A
        • Abbey SE
        • Reynolds WJ
        Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia.
        Arthritis Rheum. 2001; 45: 519-529
        • Sanudo B
        • Carrasco L
        • de Hoyo M
        • Figueroa A
        • Saxton JM.
        Vagal modulation and symptomatology following a 6-month aerobic exercise program for women with fibromyalgia.
        Clin Exp Rheumatol. 2015; 33: S41-S45
        • Schachter CL
        • Busch AJ
        • Peloso PM
        • Sheppard MS.
        Effects of short versus long bouts of aerobic exercise in sedentary women with fibromyalgia: a randomized controlled trial.
        Phys Ther. 2003; 83: 340-358
        • Abbi B
        • Natelson BH.
        Is chronic fatigue syndrome the same illness as fibromyalgia: evaluating the ‘single syndrome’ hypothesis.
        QJM. 2013; 106: 3-9
      3. World Health Organization. ICD-11 International Classification of Diseases (11th revision). Available at: https://www.who.int/standards/classifications/classification-of-diseases. Accessed October 30, 2021.

      4. Centers for Disease Control and Prevention. Fibromyalgia. Available at: https://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Accessed March 26, 2021.

        • Page MJ
        • Moher D
        • Bossuyt PM
        • et al.
        PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews.
        BMJ. 2021; 372: n160
        • Garner P
        • Hopewell S
        • Chandler J
        • et al.
        When and how to update systematic reviews: consensus and checklist.
        BMJ. 2016; 354: i3507
        • Ioannidis JPA.
        The mass production of redundant, misleading, and conflicted systematic reviews and meta-analyses.
        Milbank Q. 2016; 94: 485-514
        • Ouzzani M
        • Hammady H
        • Fedorowicz Z
        • Elmagarmid A.
        Rayyan—a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Doi SA
        • Barendregt JJ
        • Khan S
        • Thalib L
        • Williams GM.
        Advances in the meta-analysis of heterogeneous clinical trials I: the inverse variance heterogeneity model.
        Contemp Clin Trials. 2015; 45: 130-138
        • Doi SAR
        • Furuya-Kanamori L
        • Thalib L
        • Barendregt JJ.
        Meta-analysis in evidence-based healthcare: a paradigm shift away from random effects is overdue.
        Int J Evid Based Healthc. 2017; 15: 152-160
        • Higgins JPT
        • Thompson SG
        • Deeks JJ
        • Altman DG.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Furuya-Kanamori L
        • Barendregt JJ
        • Doi SAR.
        A new improved graphical and quantitative method for detecting bias in meta-analysis.
        Int J Evid Based Healthc. 2018; 16: 195-203
        • Hopkins WG.
        Individual responses made easy.
        J Appl Physiol. 2015; 118: 1444-1446
        • Williamson PJ
        • Atkinson G
        • Batterham AM.
        Inter-individual differences in weight change following exercise interventions: a systematic review and meta-analysis of randomized controlled trials.
        Obes Rev. 2018; 19: 960-975
        • Borenstein M
        • Higgins JP
        • Hedges LV
        • Rothstein HR.
        Basics of meta-analysis: I2 is not an absolute measure of heterogeneity.
        Res Synth Methods. 2017; 8: 5-18
        • IntHout J
        • Ioannidis JP
        • Rovers MM
        • Goeman JJ.
        Plea for routinely presenting prediction intervals in meta-analysis.
        BMJ Open. 2016; 6e010247
        • Higgins JP
        • Thompson SG
        • Spiegelhalter DJ.
        A re-evaluation of random-effects meta-analysis.
        J R Stat Soc Series A. 2009; 172: 137-159
        • Hopkins WG.
        How to interpret changes in an athletic performance test.
        Sportscience. 2004; 8: 1-7
        • Hopkins WG
        • Marshall SW
        • Batterham AM
        • Hanin J.
        Progressive statistics for studies in sports medicine and exercise science.
        Med Sci Sports Exerc. 2009; 41: 3-13
        • Sterne JAC
        • Savovic J
        • Page MJ
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
        • Smart NA
        • Waldron M
        • Ismail H
        • et al.
        Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX.
        Int J Evid Based Healthc. 2015; 13: 9-18
        • Maher CG
        • Sherrington C
        • Herbert RD
        • Moseley AM
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Schunemann H
        • Brozek J
        • Guyatt GH
        • Oxman A
        GRADE handbook for grading quality of evidence and strength of recommendation [updated October 2013]. The GRADE Working.
        Group. 2013; 2013; (Available at:) (. Accessed February 17, 2021)
        • Garber CE
        • Blissmer B
        • Deschenes MR
        • et al.
        Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
        Med Sci Sports Exerc. 2011; 43: 1334-1359
        • Ross R
        • Goodpaster BH
        • Koch LG
        • et al.
        Precision exercise medicine: understanding exercise response variability.
        Br J Sports Med. 2019; 53: 1141-1153
        • Inada T
        • Nozaki S
        • Inagaki A
        • Furukawa TA.
        Efficacy of diazepam as an anti-anxiety agent: meta-analysis of double-blind, randomized controlled trials carried out in Japan.
        Hum Psychopharmacol. 2003; 18: 483-487
      5. Ang C. Visualizing the world's population by age group. Available at:https://www.visualcapitalist.com/the-worlds-population-2020-by-age/. Accessed October 27, 2021.

        • Busch AJ
        • Overend TJ
        • Schachter CL.
        Fibromyalgia treatment: the role of exercise and physical activity.
        Int J Clin Rheumatol. 2009; 4: 343-380
        • Nijs J
        • Roussel N
        • Van Oosterwijck J
        • et al.
        Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice.
        Clin Rheumatol. 2013; 32: 1121-1129
        • Ruiz JR
        • Segura-Jiménez V
        • Ortega FB
        • et al.
        Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study.
        BMJ Open. 2013; 3e002722
        • Swinton PA
        • Hemingway BS
        • Saunders B
        • Gualano B
        • Dolan E.
        A statistical framework to interpret individual response to intervention: paving the way for personalized nutrition and exercise prescription.
        Front Nutr. 2018; 5: 41
        • Heidari F
        • Afshari M
        • Moosazadeh M.
        Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis.
        Rheumatol Int. 2017; 37: 1527-1539
      6. Centers for Disease Control and Prevention. Physical activity for arthritis. Available at: https://www.cdc.gov/arthritis/basics/physical-activity-overview.html. Accessed April 7, 2021.

        • Skinner JS.
        Get with the program: exercise prescription for chronic fatigue syndrome and fibromyalgia.
        ACSMs Health Fit J. 2005; 9 (2005): 16-21
        • Guglielmo D
        • Murphy LB
        • Theis KA
        • et al.
        Physical activity assessment and recommendation for adults with arthritis by primary care providers—DocStyles, 2018.
        Am J Health Promot. 2021; 35: 559-570
        • Bowen PG
        • Mankowski RT
        • Harper SA
        • Buford TW.
        Exercise is medicine as a vital sign: challenges and opportunities.
        Transl J Am Coll Sports Med. 2019; 4: 1-7
        • Partlett C
        • Riley RD.
        Random effects meta-analysis: coverage performance of 95% confidence and prediction intervals following REML estimation.
        Stat Med. 2017; 36: 301-317
      7. Borenstein M. Common mistakes in meta-analysis and how to avoid them. Biostat Inc; 2019. p 1–388.

      8. Fisher DJ, Carpenter JR, Morris TP, Freeman SC, Tierney JF. Meta-analytical methods to identify who benefits most from treatments: daft, deluded, or deft approach? BMJ2017;356:j573.

        • Watson JA
        • Ryan CG
        • Atkinson G
        • et al.
        Inter-individual differences in the responses to pain neuroscience education in adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomized controlled trials.
        J Pain. 2021; 1: 9-20
        • Mills HL
        • Higgins JPT
        • Morris RW
        • et al.
        Detecting heterogeneity of intervention effects using analysis and meta-analysis of differences in variance between trial arms.
        Epidemiology. 2021; 32: 846-854

      Linked Article

      • Correction
        Archives of Physical Medicine and Rehabilitation
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          In the article, “Are There Interindividual Differences in Anxiety as a Result of Aerobic Exercise Training in Adults With Fibromyalgia? An Ancillary Meta-analysis of Randomized Controlled Trials” ( https://www.archives-pmr.org/article/S0003-9993(22)00007-7/fulltext ), the 95% confidence interval in the second sentence of the Data Synthesis section of the abstract should be “−1.25 to −0.29”. Also, in the first row of Table 1, the 95% confidence interval likewise should be “−1.25 to −0.29”.
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