In a study conducted by Burckhardt and colleagues (1994), a combination of stretching and aerobics demonstrated changes in self-efficacy and physical functioning in 99 women with FM (86 completed the study). Subjects were randomly assigned to one of three groups:
(a) The education-only group received a 6-week self-management course;
(b) the education plus exercise training group received the course and 6 hours of training designed to assist them to exercise independently; and
(c) the control group received treatment after 3 months.

In the treatment groups, the program was shown to have significantly enhanced quality of life and self-efficacy. Other changes were smaller and more delayed than had been expected. Long-term follow-up of 67 treated subjects, primarily in the exercise training group, showed significant positive changes on the Fibromyalgia Impact Questionnaire. Among all subjects, 87% were exercising at least 3 times/week for 20 minutes or more; 46% said they had increased their exercise level since participating in the program; 70% were practicing relaxation strategies as needed; and 46% were working (at jobs) at least half-time, as opposed to 37% who had reported this at pretest.

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Short-term changes in pain perception were also reported in a study conducted by Marin et al. (1996). Thirty-eight subjects were assigned to either an aerobic exercise group or relaxation control group. The study showed that those doing aerobic exercise had a diminished number of tender points and degree of tenderness, and increased cardiovascular fitness and flexibility, as compared with the relaxation group. No changes in function or self-efficacy were shown.

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A more recent study by Jones, Burckhardt, and colleagues (2002) involving 56 women recruited from a FM patient registry compared the effects of a tailored muscle-strengthening intervention to a stretching program. The average age of the participants was 48 years. Participants had FM an average of 7.4 years. All the women demonstrated high scores for pain before the intervention. Most women were overweight, and none engaged in a regular exercise program. The strengthening component consisted of two 1-hour classes twice a week for 12 weeks. The program emphasized light resistance of all major muscle groups. The control group received a standard stretching program often prescribed for fibromyalgia.

At the end of the intervention, there were no significant differences between the two groups, indicating that either form of exercise tended to benefit the women. Although both programs demonstrated increased muscle strength and exercise tolerance, the muscle strengthening group showed a greater magnitude of change. Only six women, three from each group, showed an increase in pain. The investigators concluded that people with FM who participate in a tailored muscle-strengthening program can experience an improvement from overall disease activity without significant exercise-induced flare-ups in pain. Flexibility training alone can also result in overall improvements but to a lesser degree.

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Richards and Scott (2002) compared the effects of a cardiovascular exercise program to a flexibility and relaxation class targeted at improving symptoms in persons with fibromyalgia. More than 100 subjects who met FM diagnostic criteria were recruited from referrals of the rheumatology clinic of a London teaching hospital. Participants were randomly assigned to either cardiovascular training or relaxation and flexibility exercises. Each group met twice weekly for 12 weeks. Adherence to the program was difficult to maintain. Each participant in the cardiovascular group followed a tailored program using treadmills and exercise bicycles. The relaxation and flexibility training group performed exercises that were gradually extended to include several relaxation techniques. Participants were followed for up to 1 year after the program.

In post-program results, participants' symptoms showed the largest change. Twenty-four (35%) of the 69 subjects randomized to cardiovascular exercise reported that they were "much better" or "very much better" after 3 months compared with only 12 (18%) of those randomized to relaxation. These statistically significant differences were sustained at 1 year. The count of tender points also fell significantly in both groups, but by 1 year, the cardiovascular exercise group had sustained greater improvements. No significant differences were found between the two groups on other outcome measures, such as mental and physical fatigue and the impact of fibromyalgia on their ability to function. The program was conducted in community facilities and the authors concluded that it could be reproduced easily in most communities. Although compliance was a significant issue, they recommend the prescription of graded aerobic exercise for anyone with fibromyalgia.