An Aqua Therapy Program for an Individual with Fibromyalgia: An Evidence Based Practice

by Laura Bellinger, Melissa Obrecht, Brenna Cowling & Lisa DeFoe

Fibromyalgia (FM) is a life-long chronic pain syndrome for which there is no known structural or inflammatory cause. Those who live with FM have symptoms including fatigue, pain, weakness, stiffness and sleep disorders. These symptoms have a severe impact on everyday activities such as walking, and completion of tasks requiring use of the arms. Research has examined the effectiveness of many traditional exercise treatments for FM, particularly aerobic training with walking or running and muscle strengthening. Aqua therapy is one approach to the treatment of FM that utilizes water exercise and swimming to improve physical and psychological well- being. It helps to rehabilitate gradually, strengthens muscles and the cardiovascular system, and improves flexibility.

In this project, the researchers discussed evidence regarding the uses of aqua therapy programs for persons with FM, and developed an evidence-based aqua therapy program for a client named A.S. A.S. is a 34 year old female who was diagnosed with FM in 2003. She complains of pain, stiffness and fatigue. She notes that she has participated in pain treatment but nothing has helped to alleviate her symptoms. An aqua therapy program may be one intervention that could help improve A.S.'s function and quality of life.

Clinical Problem

As FM has become accepted as a legitimate disease, an increasing number of people have been diagnosed with it. However, with few options available to help people living with FM find comfort and relief from their symptoms, additional research needs to be done to develop more effective treatments. The limited amount of research done to examine the effectiveness of aqua therapy as a treatment for FM has focused on the lower extremities. However, according to Staud, Vierck, Robinson, and Price (2006), the upper extremities are the major source of pain in patients with FM.

Purpose of the Evidence-Based Practice Project

The purpose of this project was to propose an evidence-based protocol for an aquatics program for a client with FM experiencing symptoms of increased pain and fatigue, and decreased endurance, range of motion, and strength in the upper extremities. The proposed aquatics therapy program helped to provide evidence-based information regarding the use of this type of program to alleviate symptoms of FM.

Intervention

An aqua therapy protocol for FM was developed based on information from the book, Water exercises for fibromyalgia: The gentle way to relax and reduce pain (Rosenstein, 2006).  Exercises in the program involve whole-body movements, with particular attention paid to use of the upper extremities, as few prior research studies have examined aqua therapy programs focused on the arms.  A standardized exercise plan was developed for use during each treatment session. All of the exercises are to be performed at a depth of 4 feet of water, maintained at approximately 84 degrees Fahrenheit. Each aqua therapy session will begin with a 15-minute warm up, which includes exercises emphasizing flexibility and range of motion throughout the body, with a particular focus on the arms. The therapeutic exercise component of each session will last for 30 minutes.  Exercises in this component will focus on strength training, aerobics, and stretching of all parts of the body, with continued focus on the arms.  Each session will end with a 15-minute cool down, which will include exercises similar to those used in the warm up.

Discussion

The implications of other studies show that the use of warm water aqua therapy programs are therapeutic, there are therapeutic effects on some of the symptoms of FM, and 60 minute treatment sessions are effective. The limitations of this program are potentially the shorter duration of treatments. Another limitation of this program is the lack of literature support regarding the focus of treatment on the upper extremities. Future research could examine different water temperatures or if focusing on the upper extremities is most beneficial. Further research could include lifestyle redesign and cognitive-behavioral adaptations as a part of aqua therapy programs.

Conclusion

Aqua therapy in warm water is commonly used as a treatment for the symptoms of FM. This review provided information and guidelines for using aqua therapy as treatment for such symptoms. The program discussed in this paper varied from the current body of literature by focusing on the upper extremities for symptom management. The major findings from the current body of literature support the use of aqua therapy in warm water, and the use of the FIQ as an assessment. Based on the results of research studies previously conducted, aqua therapy seems to be an effective treatment that can be used alone or in conjunction with other treatment modalities. Further research could be done in regards to an aqua therapy program for FM that focuses on the upper extremities.

Acknowledgement

The researchers would like to thank all those who helped develop this program. Ellen Herlache, MA, OTRL, Research Coordinator for the Master of Science in Occupational Therapy program at Saginaw Valley State University, whose guidance and knowledge helped in every aspect of this program as she oversaw the researchers. Megan Baldwin, aquatics director at the Saginaw Valley State University pool, for allowing us access to equipment that could be used in a pool program.