Best practice. E-Model - prescribing physical activity and exercise for individuals with fibromyalgia.
Abstract
Fibromyalgia (FM) is a serious and debilitating condition, encompassing a wide range of symptoms. Physical therapists often advocate the incorporation of leisure time physical activity (exercise training or recreational physical activity) as an important management strategy for individuals with FM. Decisions about physical activity prescription in clinical practice are informed by a variety of sources. This topical review considers physical activity prescription using the E-Model as a framework for best practice decision making. We examine findings from randomized trials, published experts, and qualitative studies through the lens of the model's five Es: 1) evidence, 2) expectations, 3) environment, 4) ethics, and 5) experience. This approach provides a robust foundation from which to make best practice decisions. Application of this model also facilitates the identification of gaps and discrepancies in the literature, future opportunities for knowledge exchange and translation, and future research.
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Evidence supporting the efficacy of non-pharmacological treatment in fibromyalgia is strong.
“Evidence supporting the efficacy of non-pharmacological treatment in FM is strong (e.g., [67; 61; 11; 12; 15; 62])”
From Internet-enhanced management of fibromyalgia: A randomized controlled trial (2010) · cites this paper as [15]
Cites
Pollock, M. L., Gaesser, G. A., Butcher, J. D., Despr??s, J.-P., Dishman, R. K., Franklin, B. A., & Garber, C. E. (1998) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199806000-00032 · Cited by 3,051 · see citing works
The prevalence and characteristics of fibromyalgia in the general population
Wolfe, F., Ross, K., Anderson, J., Russell, I. J., & Hebert, L. E. (1995) · Arthritis & Rheumatism · doi:10.1002/art.1780380104 · Cited by 2,394 · see citing works
What drives change? Barriers to and incentives for achieving evidence‐based practice
Grol, R., & Wensing, M. (2004) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2004.tb05948.x · Cited by 1,378 · see citing works
Advances in exercise adherence
Dishman, R. K. (1994) · Human Kinetics eBooks · Cited by 1,017 · see citing works
Management of fibromyalgia syndrome
Goldenberg, D. L. (2004) · JAMA · doi:10.1001/jama.292.19.2388 · Cited by 850 · see citing works
Type of activity: resistance, aerobic and leisure versus occupational physical activity
Howley, E. T. (2001) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200106001-00005 · Cited by 672 · see citing works
Exercise for treating fibromyalgia syndrome
Busch, A. J., Barber, K. A. R., Overend, T. J., Peloso, P. M. J., & Schachter, C. L. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003786.pub2 · Cited by 609 · see citing works
Self-citationMcCain, G. A., Bell, D. A., Mai, F. M., & Halliday, P. D. (1988) · Arthritis & Rheumatism · doi:10.1002/art.1780310908 · Cited by 423 · see citing works
Women's Experiences of Stigma in Relation to Chronic Fatigue Syndrome and Fibromyalgia
Åsbring, P., & Närvänen, A.-L. (2002) · Qualitative Health Research · doi:10.1177/104973230201200202 · Cited by 394 · see citing works
Burckhardt, C. S., Mannerkorpi, K., Hedenberg, L., & BJELLE, A. O. (1994) · PubMed · Cited by 393 · see citing works
Effects of Aerobic Exercise Versus Stress Management Treatment in Fibromyalgia
Wigers, S. H., Stiles, T. C., & Vogel, P. A. (1996) · Scandinavian Journal of Rheumatology · doi:10.3109/03009749609069212 · Cited by 328 · see citing works
Mannerkorpi, K., Nyberg, B., Ahlmén, M., & Ekdahl, C. S. (2000) · PubMed · Cited by 277 · see citing works
Biofeedback/relaxation training and exercise interventions for fibromyalgia: A prospective trial
Buckelew, S. P., Conway, R., Parker, J., Deuser, W. E., Read, J., Witty, T. E., Hewett, J. E., Minor, M., Johnson, J. C., Van Male, L., et al. (1998) · Arthritis & Rheumatism · doi:10.1002/art.1790110307 · Cited by 258 · see citing works
Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial
Richards, S., & Scott, D. L. (2002) · BMJ · doi:10.1136/bmj.325.7357.185 · Cited by 232 · see citing works
Bennett, R. M., Clark, S. R., Goldberg, L., Nelson, D., Bonafede, R. P., Porter, J. M., & Specht, D. (1989) · Arthritis & Rheumatism · doi:10.1002/anr.1780320415 · Cited by 220 · see citing works
Aerobic fitness effects in fibromyalgia.
Valim, V., de Oliveira, L. M., Suda, A. L., Silva, L. J. D. A., de Assis, M. R., Neto, T. B., Feldman, D. P., & Natour, J. (2003) · PubMed · Cited by 220 · see citing works
A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia
Jones, K. D. (2000) · PubMed · doi:10.6083/m4m043qk · Cited by 215 · see citing works
HÄKKINEN, A. H., Häkkinen, K., Hannonen, P., & Alen, M. (2001) · Annals of the Rheumatic Diseases · doi:10.1136/ard.60.1.21 · Cited by 213 · see citing works
Assis, M. R., Silva, L. E., Alves, A. M. B., Pessanha, A. P., Valim, V., Feldman, D., Barros Neto, T. L. D., & Natour, J. (2006) · Arthritis Care & Research · doi:10.1002/art.21693 · Cited by 201 · see citing works
Struggling for Dignity: The Meaning of Women’s Experiences of Living with Fibromyalgia
Söderberg, S., Lundman, B. M., & Norberg, A. (1999) · Qualitative Health Research · doi:10.1177/104973299129122090 · Cited by 197 · see citing works
Schachter, C. L., Busch, A. J., Peloso, P. M. J., & Sheppard, M. S. (2003) · Physical Therapy · doi:10.1093/ptj/83.4.340 · Cited by 194 · see citing works
Self-citationHypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia.
Bennett, R. M., Cook, D. M., Clark, S. R., Burckhardt, C. S., & Campbell, S. M. (1997) · PubMed · Cited by 154 · see citing works
Kingsley, J. D., Panton, L. B., Toole, T., Sirithienthad, P., Mathis, R., & McMillan, V. M. (2005) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2005.04.014 · Cited by 146 · see citing works
Biology and therapy of fibromyalgia: pain in fibromyalgia syndrome.
Staud, R. M. (2006) · Arthritis Research & Therapy · doi:10.1186/ar1950 · Cited by 144 · see citing works
The context of health care communication in chronic illness
Thorne, S. E., Harris, S. R., Mahoney, K., Con, A. H., & McGuinness, L. (2004) · Patient Education and Counseling · doi:10.1016/j.pec.2003.11.009 · Cited by 139 · see citing works
Six- and 24-month follow-up of pool exercise therapy and education for patients with fibromyalgia
Mannerkorpi, K., Ahlmén, M., & Ekdahl, C. S. (2002) · Scandinavian Journal of Rheumatology · doi:10.1080/030097402760375223 · Cited by 131 · see citing works
Physical performance characteristics of women with fibromyalgia
Mannerkorpi, K., Burckhardt, C. S., & BJELLE, A. O. (1994) · Arthritis & Rheumatism · doi:10.1002/art.1790070305 · Cited by 127 · see citing works
The Prevalence of Fibromyalgia among Women Aged 20–49 Years in Arendal, Noway
Forseth, K. Ø., & Gran, J. T. (1992) · Scandinavian Journal of Rheumatology · doi:10.3109/03009749209095071 · Cited by 127 · see citing works
Da Costa, D., Abrahamowicz, M., Lowensteyn, I., Bernatsky, S., Dritsa, M., Fitzcharles, M.-A., & Dobkin, P. L. (2005) · Rheumatology · doi:10.1093/rheumatology/kei032 · Cited by 122 · see citing works
Ramsay, C. R. (2000) · British journal of rheumatology · doi:10.1093/rheumatology/39.5.501 · Cited by 121 · see citing works
Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study
Meyer, B. B., & Lemley, K. J. (2000) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200010000-00005 · Cited by 121 · see citing works
High or low intensity aerobic fitness training in fibromyalgia: does it matter?
van Santen‐Hoeufft, M. H. S., Bolwijn, P. H., Landewé, R., VERSTAPPEN, F. T. J., Bakker, C., Hidding, A., Kemp, D. V. D., Houben, H. H. M. L., & van der Linden, S. (2002) · PubMed · Cited by 116 · see citing works
Muscle strength and aerobic capacity in primary fibromyalgia.
Am, M., Førre, Ø. T., & Komnaes, H. B. (1991) · PubMed · Cited by 112 · see citing works
Physical therapy in the treatment of fibromyalgia
Offenbächer, G. S. M. (2000) · Scandinavian Journal of Rheumatology · doi:10.1080/030097400446706 · Cited by 110 · see citing works
The epidemiology of self-reported fibromyalgia in Canada.
McNally, J. D., Matheson, D. A., & Bakowsky, V. (2006) · PubMed · Cited by 105 · see citing works
Fasoli, S. E. (2003) · American Journal of Occupational Therapy · doi:10.5014/ajot.57.4.478c · Cited by 101 · see citing works
Valkeinen, H. (2003) · British journal of rheumatology · doi:10.1093/rheumatology/keh027 · Cited by 101 · see citing works
Exercise Training In Treatment of Fibromyalgia
Nørregaard, J., Lykkegaard, J. J., Mehlsen, J., & Danneskiold‐Samsøe, B. (1997) · Journal of Musculoskeletal Pain · doi:10.1300/j094v05n01_05 · Cited by 98 · see citing works
Häkkinen, K., Pakarinen, A., Hannonen, P., HÄKKINEN, A. H., Airaksinen, O., Valkeinen, H., & Alén, M. (2002) · PubMed · Cited by 91 · see citing works
Scandinavian Journal of Caring Sciences
Mette Elkjær RN, P., PhD, B. G., Christian Backer Mogensen MD, P., Mikkel Brabrand MD, P., & Jette Primdahl RN, P. (2010) · Scandinavian Journal of Caring Sciences · doi:10.1111/(issn)1471-6712 · Cited by 90 · see citing works
The rational management of fibromyalgia patients
Bennett, R. M. (2002) · Rheumatic Disease Clinics of North America · doi:10.1016/s0889-857x(02)00002-9 · Cited by 87 · see citing works
Living with Continuous Muscular Pain—Patient Perspectives
Henriksson, C. M. (1995) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.1995.tb00391.x · Cited by 86 · see citing works
Psychosocial Vulnerability and Maintaining Forces Related to Fibromyalgia
Hallberg, L. R. ‐., & Carlsson, S. G. (1998) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.1998.tb00482.x · Cited by 74 · see citing works
Exercise for patients with fibromyalgia: Risks versus benefits
Clark, S. R., Jones, K. D., Burckhardt, C. S., & Bennett, R. M. (2001) · Current Rheumatology Reports · doi:10.1007/s11926-001-0009-2 · Cited by 74 · see citing works
Hallberg, L. R. ‐., & Carlsson, S. G. (2000) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2000.tb00558.x · Cited by 73 · see citing works
Nonpharmacologic management strategies in fibromyalgia
Burckhardt, C. S. (2002) · Rheumatic Disease Clinics of North America · doi:10.1016/s0889-857x(01)00005-9 · Cited by 65 · see citing works
Ten Rural Women Living with Fibromyalgia Tell It Like It Is
Cudney, S. A., Butler, M. R., Weinert, C., & Sullivan, T. (2002) · Holistic Nursing Practice · doi:10.1097/00004650-200204000-00009 · Cited by 65 · see citing works
Individualizing the exercise prescription for persons with fibromyalgia
Jones, K. D., & Clark, S. R. (2002) · Rheumatic Disease Clinics of North America · doi:10.1016/s0889-857x(01)00010-2 · Cited by 60 · see citing works
Prescribing Exercise for People With Fibromyalgia
Jones, K. D., Clark, S. R., & Bennett, R. M. (2002) · AACN Clinical Issues Advanced Practice in Acute & Critical Care · doi:10.1097/00044067-200205000-00012 · Cited by 59 · see citing works
Jones, K. D., Burckhardt, C. S., & Bennett, J. A. (2004) · Arthritis Care & Research · doi:10.1002/art.20684 · Cited by 57 · see citing works
Coping with Chronic Pain: Assessing Narrative Approaches
Kelley, P., & Clifford, P. A. (1997) · Social Work · doi:10.1093/sw/42.3.266 · Cited by 57 · see citing works
Prescribing exercise for fibromyalgia patients
Clark, S. R. (1994) · Arthritis & Rheumatism · doi:10.1002/art.1790070410 · Cited by 56 · see citing works
Physiotherapy group treatment for patients with fibromyalgia—an embodied learning process
Mannerkorpi, K., & Gard, G. (2003) · Disability and Rehabilitation · doi:10.1080/09638280310001616367 · Cited by 54 · see citing works
Sencan, S., Ak, S., Karan, A., Müslümanoğlu, L., Ozcan, E. E., & Berker, E. (2004) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-2004-17204 · Cited by 50 · see citing works
Physical and other non-pharmacological interventions for fibromyalgia
Sim, J., & Adams, N. (1999) · Best Practice & Research Clinical Rheumatology · doi:10.1053/berh.1999.0041 · Cited by 49 · see citing works
Do juvenile idiopathic arthritis patients benefit from an exercise program? A pilot study
Takken, T., van der Net, J. J., & Helders, P. J. M. (2001) · Arthritis & Rheumatism · doi:10.1002/1529-0131(200102)45:1 · Cited by 47 · see citing works
HÄKKINEN, A. H., Häkkinen, K., Hannonen, P., & Alén, M. (2000) · PubMed · Cited by 43 · see citing works
Sim, J., & Adams, N. (2003) · European Journal of Pain · doi:10.1016/s1090-3801(02)00095-2 · Cited by 37 · see citing works
Clinical Epidemiology:How to do Clinical Practice Research, 3rd ed
Haynes, R. B. (2016) · Cited by 20 · see citing works
Applying exercise to the management of fibromyalgia
Ambrose, K., Lyden, A. K., & Clauw, D. J. (2003) · Current Pain and Headache Reports · doi:10.1007/s11916-003-0033-1 · Cited by 19 · see citing works
Providing Physical Activity for Older Women with Fibromyalgia Syndrome
Karper, W. B. (2000) · Activities Adaptation & Aging · doi:10.1300/j016v25n01_05 · Cited by 4 · see citing works
Busch, A. J. (2005) · Libraries and Cultural Resources (University of Calgary) · doi:10.11575/prism/21399 · Cited by 2 · see citing works
Self-citation
Flagged first, then by citations
4 of the 66 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Exercise therapy for fibromyalgia
Busch, A. J., Webber, S. C., Brachaniec, M., Bidonde, J., Bello-Haas, V. D., Danyliw, A. D., Overend, T. J., Richards, R. S., Sawant, A., & Schachter, C. L. (2011) · Current Pain and Headache Reports · doi:10.1007/s11916-011-0214-2 · Cited by 333 · see citing works
Self-citationUnderstanding fibromyalgia: lessons from the broader pain research community.
Williams, D. A., & Clauw, D. J. (2009) · The Journal of Pain · doi:10.1016/j.jpain.2009.06.001 · Cited by 250 · see citing works
Dailey, D. L., Rakel, B. A., Vance, C. G. T., Liebano, R. E., Amrit, A. S., Bush, H., Lee, K. S., Lee, J. E., & Sluka, K. A. (2013) · Pain · doi:10.1016/j.pain.2013.07.043 · Cited by 242 · see citing works
Internet-enhanced management of fibromyalgia: A randomized controlled trial
Williams, D. A., Kuper, D., Segar, M., Mohan, N., Sheth, M., & Clauw, D. J. (2010) · Pain · doi:10.1016/j.pain.2010.08.034 · Cited by 210 · see citing works
Wilbarger, J. L., & Cook, D. B. (2011) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2010.10.029 · Cited by 117 · see citing works
Şener, Ü., Üçok, K., Ulaşlı, A. M., Genç, A., Karabacak, H., Coban, N. F., Şimşek, H., & Çevik, H. (2013) · International Journal of Rheumatic Diseases · doi:10.1111/1756-185x.12237 · Cited by 84 · see citing works
Bourgault, P., Lacasse, A., Marchand, S., Courtemanche-Harel, R., Charest, J., Gaumond, I., de Souza, J. B., & Choinière, M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0126324 · Cited by 80 · see citing works
Research to Encourage Exercise for Fibromyalgia (REEF)
Ang, D. C., Kaleth, A. S., Bigatti, S. M., Mazzuca, S. A., Jensen, M. P., Hilligoss, J., Slaven, J. E., & Saha, C. (2012) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318254ac76 · Cited by 74 · see citing works
Vallejo, M. A., Ortega, J., Rivera, J., Comeche, M. I., & Vallejo-Slocker, L. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.06.006 · Cited by 68 · see citing works
Fibromyalgia treatment: the role of exercise and physical activity
Busch, A. J., Overend, T. J., & Schachter, C. L. (2009) · International Journal of Clinical Rheumatology · doi:10.2217/ijr.09.23 · Cited by 47 · see citing works
Self-citationClinical Aspects and Management of Fibromyalgia Syndrome
Chong, Y., & Ng, B.-Y. (2009) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.v38n11p967 · Cited by 27 · see citing works
Camerini, L., Giacobazzi, M., Boneschi, M., Schulz, P. J., & Rubinelli, S. (2010) · User Modeling and User-Adapted Interaction · doi:10.1007/s11257-010-9088-y · Cited by 18 · see citing works
Hardt, S., Griefahn, A., Aasdahl, L., & Armijo-Olivo, S. L. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2462773 · Cited by 4 · see citing works
Cocke, M. (2015) · KU ScholarWorks (The University of Kansas) · Cited by 3 · see citing works
Promoting Physical Activity in Fibromyalgia
Jones, K. D. (2016) · Pain Management · doi:10.2217/pmt-2016-0018
Interdisciplinary Consensus Document for the treatment of fi
de Miquel, C. A., García‐Campayo, J., Florez, M., Arguelles, J. M. G., Tarrío, E. B., Montoya, M. G., Salio, A. M., Fuentes, J. V. R., & Alberch, E. A. (2010)
Revista Portuguesa de Saúde Ocupacional - 1º Volume
Santos, M. D. O., & Almeida, A. (2016) · Revista Portuguesa de Saúde Ocupacional · doi:10.31252/rpso.vol1/2016
Como prescrever exercício em contexto laboral?
Santos, M., & Almeida, A. (2016) · Revista Portuguesa de Saúde Ocupacional · doi:10.31252/rpso.20.01.2016/2
Upplevt och önskat bemötande från vårdpersonal : en intervjustudie med kvinnor med fibromyalgi
Högman, J., & Backsten, L. (2012) · Diva portal (Dalarna University Library)
- Authors
- Busch, A. J., Thille, P., Barber, K. A. R., Schachter, C. L., Bidonde, J., & Collacott, B. K.
- Affiliations
- University of Saskatchewan (CA)
- Saskatchewan Health (CA)
- Corresponding author
- Busch, Angela J
- Venue
- Physiotherapy Theory and Practice
- Publisher
- Informa UK Limited
- Published
- 2008-01
- Volume
- 24
- Issue
- 3
- Pages
- 151-166
- ISSN
- 0959-3985 (ISSN-L)
- 1532-5040
- OpenAlex
- W2042431802
- Cited by
- 21
- References
- 66
- Citations by year
- 2025: 1 · 2019: 1 · 2016: 3 · 2015: 3 · 2013: 3 · 2012: 2
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Physiotherapy Theory and Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- fibromyalgia, physical activity prescription, exercise training, leisure-time physical activity, E-model, evidence-based practice, physiotherapy, patient expectations, knowledge translation
- MeSH terms
- Decision Support Techniques, Exercise Therapy, Fibromyalgia, Humans, Treatment Outcome, Practice Guidelines as Topic, Patient Selection, Evidence-Based Medicine, Benchmarking, Decision Support Systems, Clinical
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