Effect of a fibromyalgia rehabilitation programme in warm versus cold climate: a randomized controlled study

To study the long-term effects on symptoms and physical function of a 4-week rehabilitation programme for patients with fibromyalgia, and to determine whether there are any differences if this programme is applied in a warm or cold climate.

A total of 132 patients with fibromyalgia were randomized to a rehabilitation programme in a warm or cold climate, or to a control group without intervention. Assessments were performed before and after intervention, and after 3 and 12 months. The main outcome measures were pain, measured by tender point count (TPC), and physical function, measured with the 6-min walk test (6MWT).

There was no difference in any outcome variables at baseline. Persistent reduction in pain measured by TPC occurred only in the warm climatic setting. Mean difference (95% confidence interval (CI)) in TPC between warm and cold climate groups 1 year after the intervention was -1.7 (-2.9 to -0.5) and between the warm climate and the control group -2.2 (-3.3 to -1.0). Three months after the intervention the mean difference between the warm and cold climate groups in pain distribution (McGill mannequin) was -12 (-20 to -5) and between the warm climate and the control group -11 (-18 to -3). There were comparable improvements in physical function (6MWT) between the 2 intervention groups and the control group. The mean difference (95% CI) in 6MWT 1 year after the intervention between the warm climate and the control group was 33 (7-59) m. The corresponding value between the cold climate and the control group was 29 (3-55) m. Grip Strength (95% CI) was increased by 4.6 kg (2.3-6.4) in the warm climate and by 3.2 kg (0.9-5.5) in the cold climate compared with the control group 1 year after the intervention.

A rehabilitation programme for fibromyalgia may have a long-term effect on pain, as measured by TPC and pain distribution, when applied in a warm climatic setting, and may improve physical function regardless of the climatic setting.