Association of Moderate-to-Vigorous Physical Activity, Sedentary Time, Fat Percentage, and Physical Fitness with Gait Parameters in Women with Fibromyalgia: The Al-Ándalus Project

Gait impairments have been found in women with fibromyalgia, reducing the physical activity possibilities in this population and leading to a negative correlation with fibromyalgia impact. The aim of this study was to analyze the individual and independent associations of moderate-to-vigorous physical activity (MVPA), sedentary time, fat percentage, and physical fitness with gait parameters in women with fibromyalgia. A total of 84 women with fibromyalgia were included. MVPA and sedentary time were assessed with accelerometry, fat percentage with bioimpedance analysis, and physical fitness with field-based fitness tests. Gait was assessed during a "6 min walk test" and categorized in velocity, cadence, step length, step cycle duration, unipedal stance phase, and bipedal stance phase. Individual relationships were analyzed by partial correlations and independent relationships by linear regressions, adjusting by age and height. MVPA, sedentary time, fat percentage, and physical fitness were correlated with most gait parameters (rpartial between |0.842| and |0.219|; p ≤ 0.05). Physical fitness was independently associated with all gait parameters (β between |0.346| and |0.761|; p ≤ 0.002). In addition, MVPA was independently associated with velocity and step length (β = 0.241 and 0.292; both p = 0.004), and fat percentage was associated with bipedal stance phase (β = 0.242; p = 0.049). Good levels of MVPA, physical fitness, and adequate weight balance are associated with improved gait parameters in women with fibromyalgia.

Effectiveness of Land- and Water-based Exercise on Fatigue and Sleep Quality in Women With Fibromyalgia: The al-Ándalus Quasi-Experimental Study

OBJECTIVE

To assess the effectiveness of 24 weeks of land- and water-based exercise on fatigue and sleep quality in women with fibromyalgia, and the persistence of changes 12 weeks after exercise cessation.

DESIGN

Quasi-experimental study.

SETTING

University facilities and fibromyalgia associations.

PARTICIPANTS

Women with fibromyalgia (N=250; 50.8±7.6 years old).

INTERVENTIONS

Participants were assigned to land-based exercise (n=83), water-based exercise (n=85), or no exercise control (n=82) groups. The intervention groups engaged in a similar multicomponent exercise program for 24 weeks.

MAIN OUTCOME MEASURES

The Multidimensional Fatigue Inventory and Pittsburgh Sleep Quality Index were used.

RESULTS

Intention-to-treat analyses revealed that, compared with the control group, at week 24: (i) the land-based exercise group improved physical fatigue (mean difference -0.9 units; 95% confidence interval -1.7 to -0.1; Cohen's d=0.4) and (ii) the water-based exercise group improved general fatigue (-0.8; -1.4 to -0.1, d=0.4), and global sleep quality (-1.6; -2.7 to -0.6, d=0.6). Additionally, compared with the land-based exercise group, the water-based exercise group improved global sleep quality (-1.2; -2.2 to -0.1, d=0.4). Changes were generally not sustained at week 36.

CONCLUSION

Land-based multicomponent exercise improved physical fatigue, whereas water-based exercise improved general fatigue and sleep quality. The magnitude of the changes was small-to-medium, and no benefits were maintained after exercise cessation.

Sedentary time is associated with depressive symptoms and state anxiety in women with fibromyalgia. Could physical activity and fitness modify this association? The al-Ándalus project

PURPOSE

To analyze the associations of total and prolonged sedentary time (ST) with depressive symptoms and state anxiety in women with fibromyalgia and whether these associations are modified by moderate-to-vigorous physical activity (MVPA) and physical fitness.

METHODS

This cross-sectional exploratory study included 386 women with fibromyalgia aged 51.2 ± 7.6 years. Total ST, time in prolonged bouts of ST (≥30- and ≥60-min) and MVPA were measured with triaxial accelerometry. Depressive symptoms were assessed with the "Beck Depression Inventory-second edition," state anxiety with the "State-Trait Anxiety Inventory," and physical fitness with the "Senior Fitness Test Battery."

RESULTS

Total and prolonged ST were directly associated with depressive symptoms (total: β = 0.19, ≥30-min bout: β = 0.15, and ≥60-min bout: β = 0.12) and odds of severe depressive symptoms (all, p < 0.001). These associations generally remained significant after adjustments for MVPA and physical fitness (all, p < 0.05). Total and prolonged ST were directly associated with state anxiety (total: β = 0.11, ≥30-min bout: β = 0.12, and ≥60-min bout: β = 0.07; all, p < 0.001). These associations were generally independent of MVPA (p < 0.05) but vanished when considering physical fitness (p > 0.05).

CONCLUSIONS

Higher levels of total and prolonged ST are associated with greater depressive symptoms and state anxiety in women with fibromyalgia. MVPA did not modify these associations, although physical fitness could play a protective role specially for state anxiety.IMPLICATIONS FOR REHABILITATIONReducing sedentary time and avoiding its accumulation in prolonged periods could potentially reduce depressive symptoms and state anxiety in fibromyalgia.Higher sedentary time is associated with more severe depressive symptoms even in patients who engage in moderate-to-vigorous physical activity.Higher levels of physical fitness could attenuate the negative associations of sedentary time with depressive symptoms and, specially, state anxiety."Sit less, move more and exercise to increase your fitness" could be a positive message for people with fibromyalgia in clinical settings.

Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia

OBJECTIVES

To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM).

SETTINGS

Open-label, feasibility clinical trial.

PARTICIPANTS

Eleven people with FM (10 women).

INTERVENTIONS

The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention.

RESULTS

One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation.

CONCLUSIONS

This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support.

TRIAL REGISTRATION NUMBER

NCT03764397.

Understanding the Associations across Fibromyalgia-Related Fatigue, Depression, Anxiety, Self-Esteem Satisfaction with Life and Physical Activity in Portuguese and Brazilian Patients: A Structural Equation Modeling Analysis

Background and Objectives: Fibromyalgia are heterogeneous and differ from patient to patient; however, the most reported are general myalgia and at specific points associated with fatigue and certain psychological adversities. Physical activity can mitigate the effects of the symptoms. However, the associations between fibromyalgia-related fatigue, self-esteem, anxiety, depression, satisfaction with life and physical activity are unclear. Therefore, the aim of the present study was to understand the associations between these symptoms and whether there are differences between these associations across two distinct cultures. Materials and Methods: A total of 473 women aged between 28 and 75 years (M = 49.27; SD ± 8.28) completed five questionnaires about fibromyalgia-related fatigue, physical activity, anxiety, depression, self-esteem, and satisfaction with life. Results: Fibromyalgia-related fatigue was positively associated with depression and anxiety, depression and anxiety were negatively associated with self-esteem, self-esteem was positively associated with satisfaction with life, satisfaction with life was positively associated with physical activity and there were no differences in terms of the perceptions and associations of these variables between Portuguese and Brazilian patients. Conclusions: Our results showed the significant role of associations between these variables and a similarity in the perception and relationship of the variables between the two cultures.

Longitudinal associations of physical fitness and affect with depression, anxiety and life satisfaction in adult women with fibromyalgia

PURPOSE

This study analysed the longitudinal associations of physical fitness and affect with depression, anxiety and life satisfaction at 2- and 5-year follow-up.

METHODS

In 312 adult women with fibromyalgia, physical fitness was measured by performance-based tests and affect, depression, anxiety and life satisfaction were self-reported using the Positive and Negative Affect Schedule (PANAS), Beck Depression Inventory-second edition (BDI-II), State Trait Anxiety Inventory-I (STAI) and Satisfaction with Life Scale (SWLS), respectively. We conducted sequential linear regression analyses adjusted for baseline levels of depression, anxiety, life satisfaction, age, body fat percentage and education.

RESULTS

At the 2-year follow-up, all the associations under study were significant. At the 5-year follow-up, a number of associations remained significant. First, lowering negative affect was independently associated with lower depression, anxiety and higher life satisfaction (β's from 0.14 to 0.31). Second, favourable changes in positive affect were independently associated with lower anxiety (β = 0.21) and higher life satisfaction (β = 0.28). Third, enhancing physical fitness was related to higher life satisfaction (β = 0.16).

CONCLUSION

Reductions in negative affect were associated with more favourable depression, anxiety and life satisfaction at the 2- and 5-year follow-up. Improvements in positive affect were associated with more favourable anxiety and life satisfaction and enhancements in physical fitness were associated with higher life satisfaction. If corroborated in clinical-experimental research, these findings may guide the development of interventions that are tailored to the levels of physical fitness, affect and the outcome of interest (i.e. depression, anxiety or life satisfaction) in women with fibromyalgia.

Fibromyalgia status and depressive symptoms are linked to body mass index and physical performance in mid to late life

Fibromyalgia (FM) is a chronic pain condition that is frequently accompanied by comorbid conditions, including depression. Depression is associated with reduced physical functioning and health, disproportionately affecting middle-aged and older adults with FM. This study examined associations between FM status and depressive symptoms with body mass index (BMI) and several physical performance indicators among middle-aged and older adults. Participants included 239 community-dwelling middle-aged and older adults with or without FM. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II), BMI was objectively assessed, and physical performance was measured using the Fullerton Advanced Balance scale, 6-minute walk test, 30-second chair stand, and 8-foot up and go test. A path model using structural equation modeling yielded good fit and revealed that, compared to pain-free adult controls, participants with FM reported more depressive symptoms, which were in turn associated with reduced physical performance across all indicators except BMI, after adjusting for age and symptom severity. Findings suggest that individuals with FM demonstrate disproportionately higher depressive symptoms compared to non-FM controls, which may diminish physical performance after accounting for ageand symptom severity. This study supports FM status and depressive symptoms as important considerations when evaluating the health and disability risk of aging adults.

Physical Fitness Attenuates the Impact of Higher Body Mass and Adiposity on Inflammation in Women With Systemic Lupus Erythematosus

Aims

Higher body mass and adiposity represent independent contributors to the systemic low-grade inflammatory state often observed in patients with systemic lupus erythematosus (SLE). This study assessed the role of physical fitness in the association of body mass and adiposity with inflammation in women with SLE.

Methods

A total of 77 women with SLE were included in this cross-sectional study. We obtained body mass index, waist-to-height ratio, and body fat percentage as indicators of body mass and adiposity. Inflammation was assessed through Serum levels of C-reactive protein, interleukin 6, and leptin. Cardiorespiratory fitness was assessed with the 6-minute walk test, range of motion with the back-scratch test, and muscular strength with handgrip dynamometry.

Results

Cardiorespiratory fitness attenuated the association of both body mass index and body fat percentage with interleukin 6 (all, P<0.05). Range of motion attenuated the association of body mass index with interleukin 6 (P<0.05) and the association of body fat percentage with C-reactive protein (P<0.05). These interactions indicated that higher fitness was associated with a lower increase in inflammation per unit increase of body mass or adiposity. Muscular strength showed a non-significant trend to attenuate the association of body fat percentage with interleukin 6 (P=0.057) but potentiated the association of body fat percentage with leptin (P<0.05).

Conclusion

These findings suggest that higher levels of cardiorespiratory fitness and range of motion might attenuate the impact of higher body mass and adiposity on inflammation in women with SLE. The role of muscular strength requires further investigation.

Pain intensity and physical performance among individuals with fibromyalgia in mid-to-late life: The influence of depressive symptoms

This study investigated the mediating role of depressive symptoms among 147 middle-aged and older adults with FM in the relationship between pain intensity and 4 objective measures of physical performance: Fullerton Advanced Balance scale (FAB), 6-Minute Walk Test (6MWT), 30-Second Chair Stand (30SCS), and 8-Foot Up and Go Test (8FUPGT). Asymptotic mediation analyses revealed that depressive symptoms fully mediated the relationship between pain intensity and FAB (95% CI [-0.40, -0.10]) and 8FUPGT (CI [0.02, 0.11]) and partially mediated the relationship to 6MWT (CI [-9.15, -2.20]) and 30SCS (CI [-0.29, -0.06]). Findings support the evaluation of co-morbid depression in FM.

Lower Fatigue in Fit and Positive Women with Fibromyalgia: The al-Ándalus Project

OBJECTIVE

To analyze 1) the independent association of physical fitness, positive affect, and negative affect with the different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) and 2) whether the interactions of physical fitness, positive affect, and negative affect were associated with fatigue over and above the independent association.

DESIGN

Cross-sectional study in 420 women with fibromyalgia.

SETTING

Fibromyalgia associations from southern Spain.

METHODS

Physical fitness was measured by performance-based tests, and questionnaires were used to measure positive affect, negative affect, and different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue). Age, body mass index, and current pain level were included as potential confounders in all analyses.

RESULTS

Physical fitness was independently associated with general fatigue, physical fatigue, and reduced activity (all P ≤ 0.02). Positive affect was independently associated with all fatigue dimensions (all P < 0.001). Negative affect was independently associated with general fatigue, physical fatigue, reduced motivation, and mental fatigue (all P ≤ 0.04). The interaction of overall physical fitness and positive affect was related to general fatigue and physical fatigue (all P ≤ 0.02). Women with fibromyalgia with higher levels of overall physical fitness and positive affect showed the lowest general fatigue and physical fatigue.

CONCLUSIONS

In women with fibromyalgia, positive affect was independently and consistently associated with all dimensions of fatigue. The combination of higher levels of overall physical fitness and positive affect might serve as a buffer against general and physical fatigue in women with fibromyalgia.

The Effect of Muscular Strength on Depression Symptoms in Adults: A Systematic Review and Meta-Analysis

The aim was to systematically review the relationship between muscular strength (MS) and depression symptoms (DS) among adults, and conduct a meta-analysis to determine the pooled odds ratio (OR) for the relationship between MS and DS. The strategies employed in this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies published up to December 2019 were systematically identified by searching in the PubMed, Scopus, and Web of Science electronic databases. Inclusion criteria were: (1) cross-sectional, longitudinal and intervention studies; (2) outcomes included depression or DS; (3) participants were adults and older adults; and (4) the articles were published in English, French, Portuguese, or Spanish. A total of 21 studies were included in the review, totalling 87,508 adults aged ≥18 years, from 26 countries. The systematic review findings suggest that MS has a positive effect on reducing DS. Meta-analysis findings indicate that MS is inversely and significantly related to DS 0.85 (95% CI: 0.80, 0.89). Interventions aiming to improve MS have the potential to promote mental health and prevent depression. Thus, public health professionals could use MS assessment and improvement as a strategy to promote mental health and prevent depression.

Doctor, ask your perimenopausal patient about her physical fitness; association of self-reported physical fitness with cardiometabolic and mental health in perimenopausal women: the FLAMENCO project

OBJECTIVE

The aim of this study was to explore the association of self-reported physical fitness (PF) and its components with cardiometabolic and mental health in perimenopausal women.

METHODS

These cross-sectional analyses included 191 participants (53 ± 4 y old) from the FLAMENCO project. Self-reported PF was assessed with the International Fitness Scale (IFIS). Body mass index (BMI), fat mass (FM), waist circumference (WC), systolic and diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-C), triglycerides, C-reactive protein (CRP), and glucose were measured. The Beck's Depression Inventory, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Life Orientation Test Revised, and Positive and Negative Affect Schedule were used to assess mental health.

RESULTS

After adjusting for potential confounders, greater overall PF was associated with lower BMI, FM, WC (P < 0.001), DBP and CRP, and higher HDL-C (P < 0.05). Cardiorespiratory fitness (CRF), speed-agility, and flexibility were associated with lower BMI, WC, and FM (P < 0.001), and muscle strength (MS) with lower WC and FM (P < 0.05). In addition, CRF, MS, and speed-agility were associated with lower CRP (P < 0.01), and flexibility with enhanced triglycerides and HDL-C (P < 0.05). Overall PF and all its components were associated with lower depression, anxiety, and negative affect (P≤0.01), and greater positive affect (P≤0.05). Overall PF and MS were associated with better sleep quality (P < 0.05), and CRF, MS, and speed-agility with greater optimism (P≤0.05). Finally, overall PF showed evidence of significant association with less pharmaceutical expenditure (B = -7.2, β=-0.145, P = 0.08).

CONCLUSIONS

Self-reported PF was associated with better cardiometabolic and mental health in perimenopausal women. The IFIS might be proposed as an inexpensive, quick, and easy tool in clinical settings.

Can psychological factors be associated with the severity of pain and disability in patients with fibromyalgia? A cross-sectional study

Introduction: Psychological processes can play an important role in the expression and clinical impact of fibromyalgia.Objective: To investigate the association between the severity of pain and disability and psychological factors in patients with fibromyalgia.Methods: The following outcomes were assessed in 104 patients with fibromyalgia: pain intensity, using the Pain Numerical Rating Scale; disability, using the Patient-Specific Functional Scale; depression, using the Beck Depression Scale; anxiety, using the State-Trait Anxiety Inventory; kinesiophobia, using the Tampa Scale for Kinesiophobia; pain catastrophizing, using the Pain Catastrophizing Scale; beliefs and attitudes toward pain, using the Survey of Pain Attitudes; and the occurrence of abuse during some stage of life. Statistical analysis was performed using SPSS version 15. Initially, a simple regression analysis was performed between the dependent variables (pain and disability) and the other variables with a significance level of p ≤ 0.20, and then a multiple regression analysis was performed with a significance level of p ≤ 0.05.Results: Depression was found to be associated with pain severity (β = 0.07 [95% CI: 0.02 to 0.11], p = .00), and kinesiophobia was found to be associated with disability severity (β = -0.06 [95% CI: -0.09 to -0.02], p = .00). Depression can explain 10% of the variability of pain intensity, while kinesiophobia can explain 9% of the variability of disability.Conclusion: There are weak associations that are not clinically relevant between depression and pain severity, and between kinesiophobia and disability severity. However, other psychological factors are not associated with the severity of pain or disability.

Flexibility exercise training for adults with fibromyalgia

BACKGROUND

Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus targeting major muscle-tendon units. This review is one of a series of reviews updating the first review published in 2002.

OBJECTIVES

To evaluate the benefits and harms of flexibility exercise training in adults with fibromyalgia.

SEARCH METHODS

We searched the Cochrane Library, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Thesis and Dissertation Abstracts, AMED (Allied and Complementary Medicine Database), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up to December 2017, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.

SELECTION CRITERIA

We included randomized trials (RCTs) including adults diagnosed with fibromyalgia based on published criteria. Major outcomes were health-related quality of life (HRQoL), pain intensity, stiffness, fatigue, physical function, trial withdrawals, and adverse events.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected articles for inclusion, extracted data, performed 'Risk of bias' assessments, and assessed the certainty of the body of evidence for major outcomes using the GRADE approach. All discrepancies were rechecked, and consensus was achieved by discussion.

MAIN RESULTS

We included 12 RCTs (743 people). Among these RCTs, flexibility exercise training was compared to an untreated control group, land-based aerobic training, resistance training, or other interventions (i.e. Tai Chi, Pilates, aquatic biodanza, friction massage, medications). Studies were at risk of selection, performance, and detection bias (due to lack of adequate randomization and allocation concealment, lack of participant or personnel blinding, and lack of blinding for self-reported outcomes). With the exception of withdrawals and adverse events, major outcomes were self-reported and were expressed on a 0-to-100 scale (lower values are best, negative mean differences (MDs) indicate improvement). We prioritized the findings of flexibility exercise training compared to land-based aerobic training and present them fully here.Very low-certainty evidence showed that compared with land-based aerobic training, flexibility exercise training (five trials with 266 participants) provides no clinically important benefits with regard to HRQoL, pain intensity, fatigue, stiffness, and physical function. Low-certainty evidence showed no difference between these groups for withdrawals at completion of the intervention (8 to 20 weeks).Mean HRQoL assessed on the Fibromyalgia Impact Questionnaire (FIQ) Total scale (0 to 100, higher scores indicating worse HRQoL) was 46 mm and 42 mm in the flexibility and aerobic groups, respectively (2 studies, 193 participants); absolute change was 4% worse (6% better to 14% worse), and relative change was 7.5% worse (10.5% better to 25.5% worse) in the flexibility group. Mean pain was 57 mm and 52 mm in the flexibility and aerobic groups, respectively (5 studies, 266 participants); absolute change was 5% worse (1% better to 11% worse), and relative change was 6.7% worse (2% better to 15.4% worse). Mean fatigue was 67 mm and 71 mm in the aerobic and flexibility groups, respectively (2 studies, 75 participants); absolute change was 4% better (13% better to 5% worse), and relative change was 6% better (19.4% better to 7.4% worse). Mean physical function was 23 points and 17 points in the flexibility and aerobic groups, respectively (1 study, 60 participants); absolute change was 6% worse (4% better to 16% worse), and relative change was 14% worse (9.1% better to 37.1% worse). We found very low-certainty evidence of an effect for stiffness. Mean stiffness was 49 mm to 79 mm in the flexibility and aerobic groups, respectively (1 study, 15 participants); absolute change was 30% better (8% better to 51% better), and relative change was 39% better (10% better to 68% better). We found no evidence of an effect in all-cause withdrawal between the flexibility and aerobic groups (5 studies, 301 participants). Absolute change was 1% fewer withdrawals in the flexibility group (8% fewer to 21% more), and relative change in the flexibility group compared to the aerobic training intervention group was 3% fewer (39% fewer to 55% more). It is uncertain whether flexibility leads to long-term effects (36 weeks after a 12-week intervention), as the evidence was of low certainty and was derived from a single trial.Very low-certainty evidence indicates uncertainty in the risk of adverse events for flexibility exercise training. One adverse effect was described among the 132 participants allocated to flexibility training. One participant had tendinitis of the Achilles tendon (McCain 1988), but it is unclear if the tendinitis was a pre-existing condition.

AUTHORS' CONCLUSIONS

When compared with aerobic training, it is uncertain whether flexibility improves outcomes such as HRQoL, pain intensity, fatigue, stiffness, and physical function, as the certainty of the evidence is very low. Flexibility exercise training may lead to little or no difference for all-cause withdrawals. It is also uncertain whether flexibility exercise training has long-term effects due to the very low certainty of the evidence. We downgraded the evidence owing to the small number of trials and participants across trials, as well as due to issues related to unclear and high risk of bias (selection, performance, and detection biases). While flexibility exercise training appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events was scarce, therefore its safety is uncertain.

Cardiorespiratory fitness and age-related arterial stiffness in women with systemic lupus erythematosus

BACKGROUND

The aim of this study was twofold: (i) to examine the association of cardiorespiratory fitness with arterial stiffness in women with systemic lupus erythematosus; (ii) to assess the potential interaction of cardiorespiratory fitness with age on arterial stiffness in this population.

MATERIALS AND METHODS

A total of 49 women with systemic lupus erythematosus (mean age 41.3 [standard deviation 13.8] years) and clinical stability during the previous 6 months were included in the study. Arterial stiffness was assessed through pulse wave velocity (Mobil-O-Graph® 24 hours pulse wave velocity monitor). Cardiorespiratory fitness was estimated with the Siconolfi step test and the 6-minute walk test.

RESULTS

Cardiorespiratory fitness was inversely associated with pulse wave velocity in crude analyses (P < .05), although this relationship was attenuated when age and other cardiovascular risk factors were controlled. There was a cardiorespiratory fitness × age interaction effect on pulse wave velocity, regardless of the test used to estimate cardiorespiratory fitness (P < .001 for the Siconolfi step test; P = .005 for the 6-minute walk test), indicating that higher cardiorespiratory fitness was associated with a lower increase in pulse wave velocity per each year increase in age.

CONCLUSIONS

The results of this study suggest that cardiorespiratory fitness might attenuate the age-related arterial stiffening in women with systemic lupus erythematosus and might thus contribute to the primary prevention of cardiovascular disease in this population. As the cross-sectional design precludes establishing causal relationships, future clinical trials should confirm or contrast these findings.

The discordance between subjectively and objectively measured physical function in women with fibromyalgia: association with catastrophizing and self-efficacy cognitions. The al-Ándalus project

PURPOSE

People with fibromyalgia experience a disagreement between patient-reported (i.e., subjective) and performance-based (i.e., objective) status. This study aimed to (i) corroborate the discordance between subjectively and objectively measured physical function and (ii) examine whether catastrophizing (worrying, pain magnifying, and helpless cognitions) and self-efficacy (believing capable to manage pain) are independently associated with this discordance.

METHODS

This population-based cross-sectional study included 405 women with fibromyalgia and 193 age-matched female controls. Participants completed the Pain Catastrophizing Scale, Chronic Pain Self-efficacy Scale, and physical functioning subscales of the Revised Fibromyalgia Impact Questionnaire and Short Form-36 (SF-36) health survey. Objective physical function was measured with the Senior Fitness Test battery. Subjective and objective physical functions were expressed as deviation from the general population in standard deviation (SD) units using means and SD of the control group.

RESULTS

In fibromyalgia, subjective physical function was worse than objective physical function (p < 0.001). Higher catastrophizing was consistently associated with greater discordance between subjective and objective physical function, while self-efficacy was only significantly associated with this discordance when subjective physical function was assessed by means of the SF-36.

CONCLUSIONS

Subjective physical function is more impaired than objective physical function in fibromyalgia, yet both are markedly impaired. Catastrophizing cognitions are associated with this discordance. In particular, high catastrophizing may promote a feeling of reduced ability to do meaningful activities of daily living (i.e., restrictions) that people with fibromyalgia are actually able to. Therefore, catastrophizing should be assessed and potentially targeted when focusing on improving physical function in fibromyalgia. Implications for rehabilitation Rehabilitation should focus on physical exercise programs to help women with fibromyalgia to improve their reduced physical function. In rehabilitation settings, physical function of people with fibromyalgia should be evaluated by both subjective and objective assessments to fully understand physical functioning and to test the existence of discordance between both assessments. In case of a large discordance between subjective and objective physical function, a physical exercise program might be better complemented with cognitive management techniques to reduce catastrophizing and subjective physical dysfunction. When people with fibromyalgia experience high levels of catastrophizing, subjective assessments seem to be poor indicators of physical function.

Independent and joint associations of physical activity and fitness with fibromyalgia symptoms and severity: The al-Ándalus project

We examined independent and joint associations of objectively measured physical activity (PA) and physical fitness (PF) with pain, fatigue and the overall impact of fibromyalgia in 386 fibromyalgia women aged 51.2 ± 7.6 years. Levels of PA (light, moderate and vigorous) and PF were measured with triaxial accelerometry and the Senior Fitness Test, respectively. We used the Short-Form health survey-36 pain sub-scale and the Multidimensional Fatigue Inventory to assess pain and multiple dimensions of fatigue, respectively. The impact of fibromyalgia was studied with the Revised Fibromyalgia Impact Questionnaire (FIQR). Both, total PA and global PF were independently associated with pain pressure threshold, SF-36 pain, reduced activity, reduced motivation and FIQR total score (all, P ≤ 0.027). The associations between total PA and symptoms were weaker than those observed between global PF and symptoms. Overall, unfit patients with low PA showed a worse profile that fit patients with high PA (all, P ≤ 0.001). In summary, PA and PF are independently associated with pain, fatigue and the overall impact of fibromyalgia in women. Although PF presented greater associations with symptoms, the results suggest that both being physically active and keep adequate fitness levels might be convenient for fibromyalgia women.

Factor structure of the Positive and Negative Affect Schedule (PANAS) in adult women with fibromyalgia from Southern Spain: the al-Ándalus project

BACKGROUND

Fibromyalgia is a syndrome characterized by the presence of widespread chronic pain. People with fibromyalgia report lower levels of Positive Affect and higher levels of Negative Affect than non-fibromyalgia peers. The Positive and Negative Affect Schedule (PANAS)-a widely used questionnaire to assess two core domains of affect; namely 'Positive Affect' and 'Negative Affect' -has a controversial factor structure varying across studies. The internal structure of a measurement instrument has an impact on the meaning and validity of its score. Therefore, the aim of the present study was to assess the structural construct validity of the PANAS in adult women with fibromyalgia.

METHODS

This population-based cross-sectional study included 442 adult women with fibromyalgia (age: 51.3 ± 7.4 years old) from Andalusia (Southern Spain). Confirmatory factor analyses were conducted to test the factor structure of the PANAS.

RESULTS

A structure with two correlated factors (Positive Affect and Negative Affect) obtained the best fit; S-B χ(2) = 288.49, df = 155, p < .001; RMSEA = .04; 90% CI of RMSEA = (.036, .052); the best fit SRMR = .05; CFI = .96; CAIC = -810.66, respectively.

CONCLUSIONS

The present study demonstrates that both Positive Affect and Negative Affect are core dimensions of affect in adult women with fibromyalgia. A structure with two correlated factors of the PANAS emerged from our sample of women with fibromyalgia from Andalusia (Southern Spain). In this model, the amount of variance shared by Positive Affect and Negative Affect was small. Therefore, our findings support to use and interpret the Positive Affect and Negative Affect subscales of the PANAS as separate factors that are associated but distinctive as well.