Clinical Study Medium-/Long-Term Effects of a Specific Exercise Protocol Combined with Patient Education on Spine Mobility, Chronic Fatigue, Pain, Aerobic Fitness and Level of Disability in Fibromyalgia Erika Giannotti, 1 Konstantinos Koutsikos, 1 Maurizia Pigatto, 1 Maria Elisa Rampudda, 2 Andrea Doria, 2 and Stefano Masiero 1,3 1 Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 3, 35128 Padua, Italy 2 Department of Rheumatology, University of Padua, Via Giustiniani 2, 35128 Padua, Italy 3 Department of Rehabilitation Medicine, University of Padua, Via Giustiniani 2, 35131 Padua, Italy Correspondence should be addressed to Stefano Masiero; stef.masiero@tiscali.it Received 29 April 2013; Accepted 1 December 2013; Published 29 January 2014 Academic Editor: Joao Eurico Fonseca Copyright © 2014 Erika Giannotti et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To propose a rehabilitation protocol able to produce immediate and long-term beneicial efects on level of disability and overall performance in ADLs. Materials and Methods. Forty-one FM patients were randomized to an exercise and educational- behavioral programme group (experimental group, EG = 21) or to a control group (CG = 20). Each subject was evaluated before, at the end (T1), and ater 6 months (T6) from the conclusion of the rehabilitation treatment using the Fibromyalgia Impact Questionnaire (FIQ), the visual analogue scale (VAS), the Health Assessment Questionnaire (HAQ), the fatigue severity scale (FSS), the 6-minute walking test (6MWT), tender points count (TPC), and spinal active range of motion. he exercise protocol included 20 sessions consisting in self-awareness, stretching, strengthening, spine lexibility, and aerobic exercises, which patients were subsequently educated to perform at home. Results. he two groups were comparable at baseline. At T1, the EG showed a positive trend in FIQ, VAS, HAQ, and FSS scales and signiicant improvement in 6MWT and in most spinal active range of motion measurements (P between 0.001 and 0.04). he positive results were maintained at the follow-up. Conclusion. he proposed programme was well tolerated and produced immediate and medium-term beneicial efects improving function and strain endurance. his trial is registered with DRKS00005071 on DRKS. 1. Introduction Fibromyalgia (FM) is a chronic widespread pain disorder, commonly associated with comorbid symptoms, including fatigue, nonrestorative sleep, poor balance, cognitive/mem- ory problems, psychological distress, and impaired physical function [1], along with a reduced quality of life [2, 3]. Given the complex symptom presentation and the multiple comor- bidities associated, H¨ auser et al. [4] recommended a multi- disciplinary team in the FM treatment. Current guidelines for FM treatment management follow core principles of comprehensive assessment, education, goal setting, multimodal management including pharmacological (e.g., pregabalin, duloxetine, and milnacipran) and non- pharmacological therapies (e.g., physical activity, behavioral therapy, sleep hygiene, and education), regular education, and monitoring of treatment response [5, 6]. Physical exercise is one of the most widely recognized and beneicial forms of nonpharmacological therapy [7–9], efec- tive in reducing pain and depression and producing positive efects on physical function, itness, and global health [10], particularly in patients afected by rheumatic disease [11]. he most consistent results have been demonstrated for aerobic and strengthening exercise that, when combined with stretching, had equivalent efects on limiting pain severity among patients with FM [12, 13]. Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 474029, 9 pages http://dx.doi.org/10.1155/2014/474029