Term

Definition

Agonist‐antagonist muscle contraction

Agonist muscles and antagonist muscles refer to muscles that cause or inhibit movement. Agonist muscles cause movement to occur through their own contraction, and antagonist muscles oppose a specific movement, for example, biceps (agonist) and triceps (antagonist) muscles

Amitriptyline

A widely use tricyclic antidepressant medication; it is used to treat several mental illnesses/disorders such as major depression, anxiety, psychosis, bipolar disorder, etc. Other uses include prevention of neuropathic pain such as fibromyalgia

Biomarker

In medicine, "biomarker" is a term that is often used to refer to measurable characteristics that reflect the severity or presence of some disease state. It is often an indicator of a particular disease state or some other psychological state of an organism

Cardiorespiratory fitness

The ability of the circulatory and respiratory systems to supply oxygen to muscles during sustained physical activity

Cognitive‐behavioral therapy

A form of therapy in which the goal is to diminish symptoms by correcting distorted thinking based on negative self‐perceptions and expectations

Concomitant

Existing or concurring with something else

Detraining

Losing physical and health effects gained during exercise training by stopping exercise

Exercise

Physical activity that is planned, structured, and repetitive, and [that] has as a final or intermediate objective of improvement or maintenance of physical fitness (Garber 2011)

Exercise training

Program that is designed to meet individual health and physical fitness goals; a single exercise session should include warm‐up, stretching, conditioning, and cool‐down components. The rate of progression depends on the individual's health status and exercise tolerance

Genetic

Considered a field of biology, genetics is the study of genes within living organisms; pertaining or according to genetics

Heart rate reserve (HRR)

Difference between resting heart rate (HRrest) and maximum heart rate (HRmax). Heart rate reserve is used to determine exercise heart rates

Hormones

Any of various internally secreted compounds, such as insulin or thyroxine, formed in endocrine glands that affect the functions of specifically receptive organs or tissues when transported to them by body fluids

Inflammatory

Pathology of or caused by inflammation; biological response of body tissues to harmful stimuli such as irritants, damaged cells, or pathogens

Maximal aerobic performance

Maximum rate of oxygen consumption as measured during incremental exercise

Maximum heart rate (HRmax)

The highest number of beats per minute your heart can reach during maximum physical exertion. This rate is individual and depends on hereditary factors and age

Microtrauma

Trauma to muscle cells

Milnacipran

A serotonin‐norepinephrine reuptake inhibitor

Min × d⁻¹

Minutes per day

Monoamine oxidase inhibitors

An oxidoreductase inhibitor of a single amino group neurotransmitter

Muscle strength

A physical test of the amount of force a muscle can generate

Neurotransmitters

Any of several chemical substances, such as epinephrine or acetylcholine, that transmit nerve impulses across a synapse to a postsynaptic element, such as another nerve, muscle, or gland

Non‐pharmacological

Treatment that does not include medication

OMERACT

OMERACT (Outcome Measures in Rheumatology) is an independent initiative of international health professionals interested in outcome measures in rheumatology. Over the past 20 years, OMERACT has served a critical role in the development and validation of clinical and radiographic outcome measures in rheumatoid arthritis, osteoarthritis, psoriatic arthritis, fibromyalgia, and other rheumatic diseases (www.omeract.org). OMERACT is linked to the Cochrane Collaboration Musculoskeletal Review Group, where outcomes endorsed by OMERACT are recommended for use in Cochrane Systematic Reviews

Pathophysiology

The physiology of abnormal or diseased organisms or their parts

Perceived exertion

Amount of effort that is perceived by someone, usually rated on a scale of 6 to 20 or 1 to 10

Physical activity

Any bodily movement produced by skeletal muscles that results in energy expenditure above resting (basal) levels. Physical activity broadly encompasses exercise, sports, and physical activities done as part of daily living, occupation, leisure, and active transportation (Garber 2011)

Physical fitness

Ability to carry out daily tasks with vigor and alertness, without undue fatigue and with ample energy to enjoy (leisure) pursuits and to meet unforeseen emergencies. Physical fitness is operationalized as "[a set of] measurable health and skill‐related attributes"

Physical function

The capacity of an individual to carry out physical activities of daily living. Physical function reflects motor function and control, physical fitness, and habitual physical activity and is an independent predictor of functional independence, disability, and morbidity

Physiology

Branch of biology dealing with the functions and activities of living organisms and their parts, including all physical and chemical processes

Predicted maximum heart rate (HRmax‐p)

HRmax‐p is a score equivalent to maximum heart rate (HRmax). HRmax‐p may provide a way to define training intensities as percentages of maximum heart rate and to follow maximum heart rate changes due to training without an exhaustive maximal stress test

Pregabalin

An antiepileptic medication

Prevalence

Rate of occurrence of a condition, usually expressed on a per‐year basis

Skewness

Not every distribution of data is symmetrical ‐ sets of data that are not symmetrical are said to be "asymmetrical." The measure of how asymmetrical a distribution can be is called "skewness"

Sleep disturbance

A score derived from a questionnaire that measures sleep quantity and quality. The Medical Outcomes Survey Sleep Scale measures 6 dimensions of sleep (initiation, staying asleep, quantity, adequacy, drowsiness, shortness of breath, snoring)

Somatic comorbidities

Conditions of the body related to a disease

Symptoms

Patients' perceptions of an "abnormal" physical, emotional, or cognitive state

Tenderness

Pain evoked by tactile pressure

Intensity

%VO₂ reserve/% HR reserve

% HRmax

Perceived exertion scale (RPE) 6 to 20

Very light

< 37

< 57

RPE < 9

Light

37 to 45

57 to 63

RPE 9 (very light) to 11 (fairly light)

Moderate

46 to 63

64 to 76

RPE 12 (fairly light) to 13 (somewhat hard)

Vigorous

64 to 90

77 to 95

RRE 14 (somewhat hard to 17 (very hard)

Near maximal to maximal

≥ 91

≥ 96

RPE ≥ 18 (very hard)

Outcome

Name of Instrument or index/subscale

Health‐related quality of life

FIQ Total (0‐100)

Pain intensity/interference

Current pain (VAS), FIQ pain (VAS), SF‐36 bodily pain (interference)

Fatigue

VAS (0‐100), FIQ fatigue (0‐100), SF‐36 vitality (0‐100), Fatigue Severity Scale (9‐63), Multidimensional Fatigue Inventory (4‐20)

Stiffness

FIQ stiffness

Physical function

SF‐36 physical functioning (0‐100), FIQ physical function (0‐100), Sickness Impact Profile (0‐68), Health Assessment Questionnaire (HAQ)

Maximal cardiorespiratory function

Oxygen uptake (VO₂max), maximum work capacity (w)

Submaximal cardiorespiratory function

6‐minute walk test (distance in meters), Astrand submaximal cycle ergometer test (heart rate at a steady state workload)

Adverse events

Not a standardized instrument or index/narrative information

Author, year, intervention

Frequency, times per week – length in weeks

Intensity/ACSM intensity classification

Time/Duration/Session, minutes

Type/Mode

Aerobic vs control

Gowans 2001

3 times/wk

23 weeks

60%‐75% age‐adjusted HRmax
ACSM: low to moderate

30'

Supervised water walking/running progressing to land walking/running

Kayo 2011

3 times/wk

16 weeks

40%‐50% HRR at week 1 to 60%‐70% HRR by week 16
ACSM: moderate at week 1 to vigorous by week 16

˜ 60'

Supervised indoor or outdoor walking

King 2002

3 times/wk

12 weeks

60%‐75% predicted HRmax
ACSM: light to moderate

Starting duration 10 to 15' progressing to 20 to 40'

Supervised walking, aquacise (deep and shallow water), or low‐impact aerobics

Mengshoel 1992

2 times/wk

20 weeks

120‐150 beats per minute

ACSM: moderate to vigorous

60'

Supervised low‐impact aerobic dance program

Nichols 1994

3 times/wk

8 weeks

60%‐70% predicted HRmax/age

ACSM: light to moderate

Unclear

Supervised fast‐paced walking on an indoor track

Sanudo 2010

2 times/wk

24 weeks

60%‐65% HRmax (steady state aerobics) and 75%‐80% HRmax (interval training)

ACSM: light to moderate and moderate to vigorous

45‐60’

Supervised aerobics including continuous walking with arm movements and jogging; interval training including aerobic dance and jogging

Schachter 2003 Short bout

3 to 5 times/wk

16 weeks

40%‐50% HRR at week 1, 60%‐70% HRR by week 10

ACSM: moderate at week 1, vigorous by week 10

2/d, 5' at week 1 to 15'
at week 9

Home program of low‐impact aerobics to videotaped instructor and music, rhythmical movements of lower body muscles. Supervision at 0, 4, 8, and 12 weeks

Schachter 2003

Long bout

3 to 5 times/wk

16 weeks

40%‐50% HRR at week 1, 60%‐70% HRR by week 10

ACSM: moderate at week 1; vigorous by week 10

10' at week 1 to 30'
at week 9

Home program of low‐impact aerobics to videotaped instructor and music, rhythmical movements of lower body muscles. Supervision at 0, 4, 8, and 12 weeks

Sencan 2004 Aerobic exercise

3 times/wk

6 weeks

Not specified

40’

Cycle ergometry. Supervision unclear

Wigers 1996

3 times/wk

14 weeks

Tempo gradually increased up to, and decreased down from, 4 periods of 60%‐70% HRmax

ACSM: light to moderate

45’

Supervised movement to music and games

Aerobic vs aerobic2

Mannerkorpi 2010 AE: Nordic walking

2 times/wk

15 weeks

10’ at RPE 9‐11 2' intervals of RPE 13‐15, alternated with 2' at RPE 10 to 11

ACSM: 10’ light, 2’ intervals moderate to vigorous alternated with 2’ light.

20’

Supervised walking in parks and forests with flat areas and small hills

Mannerkorpi 2010

AE2: low‐intensity walking

1 time/wk

15 weeks

RPE 9 to 11
ACSM: light

20’

Supervised walking in parks and forests with flat areas and small hills

Ramsay 2000.

AE: exercise class

1 time/wk

12 weeks

Not specified

60’

Supervised graded circuit exercises consisting of step‐ups, sitting to standing, skipping, jogging on the spot, alternate side bends, circling arms with increasing weights, plus encouragement to continue and increase exercises at home

Ramsay 2000

AE2: single class

1 session

12 weeks

Not specified

60’

Demonstration of aerobic exercises, stretching and relaxation technique, plus written advice on aerobic exercises plus stretching and relaxation

Schachter 2003: AE: short bout

3 to 5/wk

16 weeks

40%‐50% HRR at week 1, 60%‐70% HRR by week 10
ACSM: moderate at week 1, vigorous by weeks 10‐16

2/d 5' up to 15'

Home program of low‐impact aerobics to videotaped instructor and music, rhythmical movements of lower body muscles. Supervision at 0, 4, 8, and 12 weeks

Schachter 2003

AE2: long bout

3 to 5/wk

16 weeks

40%‐50% HRR at week 1, 60%‐70% HRR by week 10

ACSM: moderate at week 1, vigorous by weeks 10‐16

10' up to 30'

Home program of low‐impact aerobics to videotaped instructor and music, rhythmical movements of lower body muscles. Supervision at 0, 4, 8, and 12 weeks

Aerobic vs other (education or stress management training)

Fontaine 2007

Group session every 2 weeks AE: 5‐7 times/wk

12 weeks

Moderate intensity

ACSM: moderate
Review authors used appropriate references to help translate "moderate" into action

10’ and increase daily 5’/wk to at least 30’

Brisk walking and other modes of aerobic activity (+ group session/supervision)

Fontaine 2010

5‐7 times/wk

12 weeks

Moderate (breathing heavily but able to keep a conversation) + 15’ of above usual level

ACSM: moderate

Review authors used appropriate references to help translate "moderate" into action

60’

Walking (the most common form of LPA) and other forms (eg, garden/mowing the lawn); household activity (eg, vacuuming); and sports activity (eg, cycling, swimming, field hockey) (+ group sessions/supervision)

King 2002

3 times/wk

12 weeks

60%‐75% predicted HRmax

ACSM: light to moderate

Starting duration 10 to 15' progressing to 20 to 40'

Supervised walking, aquacise (deep and shallow water), or low‐impact aerobics

Sencan 2004

3 times/wk

6 weeks

Not specified

40’

Cycle ergometry. Supervision unclear

Wigers 1996

3 times/wk

14 weeks

Tempo gradually increased up to, and decreased down from, 4 periods at 60%‐70% HRmax ACSM: light to moderate

45’

Supervised movement to music and games

Met ACSM criteria

Did not meet ACSM criteria

Not enough information to judge

Fontaine 2007; Fontaine 2010; Kayo 2011; Schachter 2003 met ACSM guidelines for healthy adults. Gowans 2001 met ACSM criteria for individuals who are sedentary/have no habitual activity/are extremely deconditioned

King 2002: based on frequency and duration (only 3/wk, light to moderate); Mannerkorpi 2010: based on frequency and duration (only twice or once a week with 20' session duration); Mengshoel 1992: based on frequency of 2 times/wk; Nichols 1994: based on frequency and duration (only twice a week); Ramsay 2000: based on frequency (only once a week); Sanudo 2010: based on frequency (only twice a week) for aerobics; Wigers 1996: intensity too low, duration too short (only 18‐20’ at HR 60%‐70%)

Sencan 2004

Outcome

All studies

MD (95% CI), number of studies (participants), I²

Low risk of selection bias

MD (95% CI), number of studies (participants), I²

Low risk of attrition bias

MD (95% CI), number of studies (participants), I²

Detection bias

HRQL

‐7.89 (‐13.23 to ‐2.55), 5 studies (372), I²= 58%

‐10.47 (‐20.79 to ‐0.15), 3 studies (246), I² = 77%

> 20% was not present ‐ this sensitivity analysis was not conducted

Sensitivity analysis not conducted

Pain

‐11.06 (‐18.34 to ‐3.77), 6 studies (351), I²= 59%

‐8.38 (‐17.88 to 1.12), 3 studies (246), I² = 59%

‐11.71 (‐19.93 to ‐3.50), 5 studies (326), I² = 66%

Sensitivity analysis not conducted

Quality assessment

Number of participants

Quality

Importance

Number of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other comments

AE only

Control

HRQL (follow‐up 12 weeks after end of intervention; assessed with 0‐100 scale, lower is best)

2

Randomized trials

Serious^a

Serious^b

Not serious

Serious^c

60

48

⊕⊝⊝⊝
very low

CRITICAL

Pain intensity (follow‐up 12 weeks after end of intervention to 4 years; assessed with 0‐100 scale, lower is best)

3

Randomized trials

Serious^a

Not serious

Not serious

Serious^c

64

70

⊕⊕⊝⊝
low

CRITICAL

Fatigue (follow‐up from 12 weeks after end of intervention to 4 years; assessed with 0‐100 scale, lower is best)

2

Randomized trials

Serious^a

Serious^b

Not serious

Serious^c

50

50

⊕⊝⊝⊝
very low

IMPORTANT

Stiffness: not measured

Physical function (follow‐up at 12 weeks after end of intervention; assessed with 0‐100 scale, lower is best)

1

Randomized trials

Serious^d

Not serious

Not serious

Serious^c

One study

30

30

⊕⊝⊝⊝
very low

IMPORTANT

All‐cause withdrawal (follow‐up from 12 weeks after end of intervention to 4 years)

3

Randomized trials

Serious^a

Not serious

Not serious

Serious^c

22/92 (23.9%)

25/84 (29.8%)

⊕⊕⊝⊝
low

IMPORTANT

Adverse events: not reported

Quality assessment

Number of participants

Quality

Importance

Number of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

AE intervention

AE control

HRQL, 0‐100, lower is best

2

Randomized trial

Serious^a

Not serious

Not serious

Serious^b

Studies not pooled

79

83

⊕⊕⊝⊝
low

CRITICAL

Pain intensity, 0‐100, lower is best

3

Randomized trial

Serious^b

Not serious

Not serious

Serious^c

Studies not pooled

117

121

⊕⊕⊝⊝
low

CRITICAL

Fatigue, 0‐100, lower is best

2

Randomized trial

Serious^a

Not serious

Not serious

Serious^b

Studies not pooled

79

83

⊕⊕⊝⊝
low

IMPORTANT

Stiffness, 0‐100, lower is best

1

Randomized trial

Serious^a

Not serious

Not serious

Serious^b

One study

51

56

⊕⊝⊝⊝
very low

IMPORTANT

Physical function, 0‐100, lower is best

2

Randomized trial

Serious^a

Serious^d

Not serious

Serious^b

80

84

⊕⊝⊝⊝
very low

IMPORTANT

All‐cause withdrawals

2

Randomized trial

Serious^a

Not serious

Not serious

Serious^b

20/85 (23.5%)

25/89 (28.1%)

⊕⊕⊝⊝
low

IMPORTANT

Adverse events: not reported

Quality assessment

Number of participants

Quality

Importance

Number of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

AE

Other

HRQL, 0‐100, lower is best (AE and lifestyle vs education or SMP)

3

Randomized trial

Serious^a

Not serious

Not serious

Serious^b

97

92

⊕⊕⊝⊝
low

CRITICAL

Pain intensity, 0‐100, lower is best (AE only vs education or SMP and AE only vs medication)

4

Randomized trial

Serious^a

Serious^c

Not serious

Serious^b

94

91

⊕⊝⊝⊝
very low

CRITICAL

Fatigue, 0‐100, lower is best (AE and lifestyle vs education or SMP)

3

Randomized trial

Serious^a

Not serious

Not serious

Serious^b

74

71

⊕⊕⊝⊝
low

IMPORTANT

Withdrawals

4

Randomized trial

Serious^a

Not serious

Not serious

Serious^b

21/130 (16.2%)

25/125 (20.0%)

⊕⊕⊝⊝
low

IMPORTANT

Stiffness and physical function: not measured

Adverse events: reported for 1 study: King 2002: "No complications or adverse effects were observed during the study period among patients who completed the treatment protocols" (page 3 of 8)