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Do women with fibromyalgia adhere to walking for exercise programs to improve their health? Systematic review and meta-analysis

Abstract Background: Walking is recommended for fibromyalgia, but the rate of adherence to this exercise is not known. Poor adherence to physical exercise can limit the effectiveness in health benefits. Objectives: To examine adherence to interventions that include walking for fibromyalgia and to explore its moderators among the characteristics of patients, of the walking prescription and of the interventions. Data sources: References from 2000 to 2016 have been collected through PubMed, PsycINFO, CINAHL, SPORTDiscus, Cochrane, and Teseo. Study selection: We included quasi-experimental and randomized controlled trials in adults with fibromyalgia that involved walking for exercise. Two authors screened records independently and disagreements were resolved by discussion. Data extraction: Independently extracted by two assessors. Methodological quality of the studies was assessed using an ad hoc scale. Data synthesis: Nineteen trials, 32 experimental groups, recruited a total of 983 participants (96.78% women) with mean ages between 45 and 60.60. Adherence to the intervention program was reported in 19 of 32 experimental groups and ranged, on average, from 73 to 87.20% depending on the type of assessment. Most relevant moderators of adherence were the recruitment of participants through physicians and the nurses as supervisors of exercise. Conclusion: Adherence rates (attendance at sessions) to programs with walking were high. However, a lack of information precludes knowledge of whether participants sustained walking between sessions or after the treatment. Further work is required to examine in greater depth such contextual variables of interventions as the professional-participant relationship or to explore other possible moderators such as patient expectations of the treatment. Implications for rehabilitation Adherence to walking programs is more likely if doctors recommend the attendance at them. The combination with other activities may result in better adherence to walking than those that are only-walking exercise. The adherence to walking programs was larger in those in which nurses supervised the exercise. It is necessary to have adherence as objective, improving the record of adherence during treatment, assessing it between sessions and with a follow-up after the end of treatment.