Skip to content
Back

MSK Pain -CP – Improves mental health

Evidence Summary (Updated 2022)
Whilst physical activity interventions have been shown to improve a number of patient outcomes, there is conflicting evidence regarding depression and psychological function. One RCT included within a Cochrane review demonstrated a large effect in favour of resistance exercises on depression in those with fibromyalgia, but the same review demonstrated no effect on overall mental health (4). An earlier Cochrane review concluded that psychological function cannot be expected to improve with aerobic exercises in those with fibromyalgia (1).
A review of female patients with fibromyalgia concluded that resistance training can improve the mental health of this population group with significant improvement seen in depression and anxiety. Resistance training and aerobic training had a greater effect than flexibility training (5 ). A further review of a similar population group had conflicting results with 2 out of 3 included RCTs finding improvement in depressive symptoms and the third finding no significant difference after a 15 week strength training intervention (3).

Quality of Evidence
Grade C – low quality

Strength of recommendation
Grade 1 – strong recommendation. Whilst the evidence supporting an improvement in mental health outcomes is poor, expert clinical consensus is that patients should be informed of the positive effect of physical activity on their mental health.

Conclusion
Regular physical activity is known to be an effective intervention in those with depression, but the quality of evidence in the chronic pain population is poor. Expert consensus is that the reduced pain and improved function that can be expected from regular physical activity is likely to improve a patient’s mental wellbeing. Consider referring those with a significant psychosocial contribution to their presentation to exercise intervention programmes with a psychological component, ideally group programmes

References 

1.           Busch AJ, Barber KAR, Overend TJ, Peloso PMJ, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev [Internet]. 2007 [cited 2022 Aug 24];(4). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003786.pub2/full

2.           Estévez-López F, Maestre-Cascales C, Russell D, Álvarez-Gallardo IC, Rodriguez-Ayllon M, Hughes CM, et al. Effectiveness of Exercise on Fatigue and Sleep Quality in Fibromyalgia: A Systematic Review and Meta-analysis of Randomized Trials. Arch Phys Med Rehabil [Internet]. 2021 Apr 1 [cited 2022 Jul 8];102(4):752–61. Available from: https://pubmed.ncbi.nlm.nih.gov/32721388/

3.           Andrade A, de Azevedo Klumb Steffens R, Sieczkowska SM, Peyré Tartaruga LA, Torres Vilarino G. A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Adv Rheumatol (London, England) [Internet]. 2018 Oct 22 [cited 2022 Jul 11];58(1):36. Available from: https://pubmed.ncbi.nlm.nih.gov/30657077/

4.           Busch AJ, Webber SC, Richards RS, Bidonde J, Schachter CL, Schafer LA, et al. Resistance exercise training for fibromyalgia. Cochrane database Syst Rev [Internet]. 2013 Dec 20 [cited 2022 Aug 24];2013(12). Available from: https://pubmed.ncbi.nlm.nih.gov/24362925/

5.           Vilarino GT, Andreato LV, de Souza LC, Branco JHL, Andrade A. Effects of resistance training on the mental health of patients with fibromyalgia: a systematic review. Clin Rheumatol [Internet]. 2021 Nov 1 [cited 2022 Jul 11];40(11):4417–25. Available from: https://pubmed.ncbi.nlm.nih.gov/33987785/