Pain and functional capacity in female fibromyalgia patients

Test-Retest Reliability of Isokinetic Strength in Lower Limbs under Single and Dual Task Conditions in Women with Fibromyalgia

Background: Previous research has established good test-retest reliability for isokinetic dynamometry in fibromyalgia. However, the reliability of this test under dual-task conditions has not been investigated in fibromyalgia. Methods: A total of 10 women with fibromyalgia participated in this study. Participants completed the concentric/concentric test. The dual-task condition involved subtracting two by two while performing the test. Results: Reliability analysis under the single condition showed "poor" to "excellent" values for maximum peak torque in knee extension and "moderate" to "excellent" values for average. "Poor" to "excellent" reliability values were found in knee flexion for the maximum and average. Dual-task condition in knee extension ranged from "moderate" to "excellent" for maximum and average values, and in knee flexion, it ranged from "poor" to "excellent" for maximum value and from "moderate" to "excellent" for average value. Conclusions: Isokinetic dynamometry demonstrated sufficient reliability for measuring strength in knee extension maximum and average during single-task and dual-task conditions, along with knee flexion dual-task average in fibromyalgia. For knee flexion single-task maximum and average and knee flexion dual-task maximum, we did not obtain sufficiently reliable measurements. Only the concentric/concentric test has been studied, and future studies with a larger sample size are needed in order to generalize the results.

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.

Test-Retest Reliability and Concurrent Validity of the 3 m Backward Walk Test under Single and Dual-Task Conditions in Women with Fibromyalgia

BACKGROUND

Previous studies have reported good test-retest reliability for the 3 m backward test (3MBWT) in different populations. However, reliability of the 3MBWT has not been studied in fibromyalgia (FM) under single and dual-task conditions; Methods: A total of 21 women with FM participated in this study. Participants completed the Revised Fibromyalgia Impact Questionnaire and two physical fitness tests: the 3MBWT and the Timed Up and Go (TUG). The dual-task condition consisted of subtracting two by two while performing the test, starting from a random number less than 100; Results: Values showed that the 3MBWT can be considered reliable under single and dual-task conditions when measured with both a manual stopwatch and a Chronopic automatic stopwatch. A strong concurrent validity was shown of 3MBWT and TUG results in the test and retest and the different devices. The relationship between the performance of the 3MBWT in test and retest conditions under single and dual-task conditions measured with different devices and the impact of the disease were high; Conclusions: The 3MBWT is a reliable tool under the single and dual-task conditions in women with FM. It shows higher reliability values when time is taken using a Chronopic. This test also shows high concurrent validity with the TUG test. Its performance is related to the impact of the disease.

The Mediating Role of Depression and Pain Catastrophizing in the Relationship between Functional Capacity and Pain Intensity in Patients with Fibromyalgia

Background

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition characterized by widespread pain, sleep problems (i.e., insomnia and unrefreshing sleep), fatigue, cognitive, and emotional difficulties. Although pain has been proposed the factor mostly impacting in the FMS patients' function, emotional and psychological FMS-associated factors are also known to exert a negative impact in quality of life and functional capacity. Nonetheless, the relationship between these factors and functional limitations in FMS patients is considered to be complex and not clearly defined. Therefore, the present study is aimed at assessing the associations between FMS functional capacity, FMS symptoms (pain, fatigue, insomnia, depression, and state and trait anxiety), and associated psychological factors such as pain catastrophizing, as well as the possible mediating role of these latter in the relationship between pain and FMS functional capacity.

Method

115 women diagnoses with FMS completed a set of self-administered questionnaires to evaluate the clinical and psychological variables of the study.

Results

FMS functional capacity was positively associated with the majority of FMS symptoms except state anxiety. Regression analyses confirmed a greater prediction for FMS functional capacity by depression, fatigue, and pain catastrophizing, in this sequence. Both, pain catastrophizing and depression were important factors mediating the association between clinical pain (total and intensity) and FMS functional capacity.

Conclusions

Findings support a key role of pain catastrophizing and depression in the disability associated to pain in FMS. Treatment goals directed to lessen depression and pain catastrophizing levels should be promoted to reduce the impact of pain in FMS patients' daily function.

What Mathematical Models Are Accurate for Prescribing Aerobic Exercise in Women with Fibromyalgia?

Simple Summary

Intensity prescription for cardiorespiratory exercises is crucial for achieving health/fitness benefits. However, not all of the population can access a cardiopulmonary exercise test, either for economic reasons or location resources, to determine their ventilatory thresholds. Therefore, different mathematical models can predict the intensity based on the maximum or reserve heart rate. Exercise prescription guidelines indicate that people with fibromyalgia should exercise at 60% of their VO₂max. However, people with fibromyalgia suffer from dysautonomia, which could lead to chronotropic incompetence, the inability to increase heart rate with increasing exercise intensities. Therefore, this study aimed to investigate the relationship and level of agreement between different mathematical models and the heart rate obtained from a cardiopulmonary exercise test at their ventilatory threshold 1. The results showed that the well-known “220 − age” at 76% and the mathematical model designed for people with fibromyalgia “209 − 0.85 × age” at 76% showed a significant level of agreement. However, Tanaka and Karvonen’s formula did not show a significant level of agreement. Thus, the “220 − age” at 76% and “209 − 0.85 × age” at 76% can be used in people with FM to prescribe aerobic exercise.

Abstract

Objectives: This article aims to verify the agreement between the standard method to determine the heart rate achieved in the ventilatory threshold 1 in the cardiopulmonary exercise testing (VT1) and the mathematical models with exercise intensities suggested by the literature in order to check the most precise for fibromyalgia (FM) patients. Methods: Seventeen women with FM were included in this study. The VT1 was used as the standard method to compare four mathematical models applied in the literature to calculate the exercise intensity in FM patients: the well-known “220 − age” at 76%, Tanaka predictive equation “208 − 0.7 × age” at 76%, the FM model HRMax “209 – 0.85 × age” at 76%, and Karvonen Formula at 60%. Bland–Altman analysis and correlation analyses were used to explore agreement and correlation between the standard method and the mathematical models. Results: Significant correlations between the heart rate at the VT1 and the four mathematical estimation models were observed. However, the Bland-Altman analysis only showed agreement between VT1 and “220 − age” (bias = −114.83 + 0.868 × x; 95% LOA = −114.83 + 0.868 × x + 1.96 × 7.46 to −114.83 + 0.868 × x − 1.96 × 7.46, where x is the average between the heart rate obtained in the CPET at VT1 and “220 − age”, in this case 129.15; p = 0.519) and “209 − 0.85 × age”(bias = −129.58 + 1.024 × x; 95% LOA = −129.58 + 1.024 × x + 1.96 × 6.619 to −129.58 + 1.024 × x − 1.96 × 6.619, where x is the average between the heart rate obtained in the CPET at VT1 and “209 − 0.85 × age”, in this case 127.30; p = 0.403). Conclusions: The well-known predictive equation “220 − age” and the FM model HRMax (“209 − 0.85 × age”) showed agreement with the standard method (VT1), revealing that it is a precise model to calculate the exercise intensity in sedentary FM patients. However, proportional bias has been detected in all the mathematical models, with a higher heart rate obtained in CPET than obtained in the mathematical model. The chronotropic incompetence observed in people with FM (inability to increase heart rate with increasing exercise intensities) could explain why methods that tend to underestimate the HRmax in the general population fit better in this population.

Individuals with fibromyalgia have a different gait pattern and a reduced walk functional capacity: a systematic review with meta-analysis

Background

The aim of the present study was to perform a systematic review and meta-analysis comparing walking test performance and gait pattern between individuals with and without fibromyalgia (FM).

Methodology

This systematic review was registered in PROSPERO with the following reference: CRD42018116200.The search for the scientific articles in this systematic review was carried out using the MEDLINE, SCOPUS, PEDRO, CINHAL and WEB OF SCIENCE databases. A combination of three conceptual groups of terms was used: (1) fibromyalgia; (2) walk (performance) tests; and (3) gait analysis. The included articles were analyzed for both functional and pattern of walking data of patients with FM. In order to provide a better estimate of the difference between individuals with and without FM on gait, a meta-analysis was performed on the 6MWT (6-minute walk test).

Results

Thirty-six studies were analyzed, with a total population of 4.078 participants (3.369 FM and 709 individuals without FM). From a functional point of view, the 6MWT distance covered by the group of individuals without FM was significantly greater than that of the individuals with FM in all the analyzed studies. In addition, when comparing the results obtained in the gait pattern analysis, it was observed that individuals with FM walked slower, with a shorter stride length and lower cadence compare to individuals without FM.

Conclusions

It is possible to affirm that individuals with FM perform walking tests differently than individuals without FM. It was observed that individuals with FM walk performing a cycle of shorter length and lower frequency, producing a slower gait, which results in a shorter distance traveled, in the same period of time, with respect to healthy subjects.

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.

The Therapeutic Effects of Whole-Body Vibration in Patients With Fibromyalgia. A Randomized Controlled Trial

Fibromyalgia is a chronic pain disease with few effective therapeutic options. We evaluated the efficacy of a 12-weeks therapy program that involves the use of whole body vibration in patients with fibromyalgia. The experimental group (N = 20 patients) participated in a neuromuscular training with a rotational whole body vibration platform for 12 weeks. The control group (N = 20 patients) received no physiotherapy treatment. The following variables were assessed before, after and 3 months after the therapy program: Fibromyalgia impact questionnaire, pain intensity, quality of life, sensitivity measurements (pressure pain thresholds, vibration thresholds), motor function tasks (Berg scale, 6-min walk test, isometric back muscle strength), and static and dynamic balance. We found improvements in the indexes of functional disability, static equilibrium and vibration sensitivity and a reduction of pain sensitivity. Our results showed that the intervention group improved almost all parameters immediately after the therapy program, in contrast to the control group that showed no changes. These improvements were not maintained in the follow-up. The whole body vibration therapy can be an effective therapy in patients with fibromyalgia and it can improve symptomatology and quality of life in these patients.

Physical activity in the treatment of fibromyalgia

International treatment recommendations for fibromyalgia (FM) highlight the importance of adapted physical activity (APA) combined with patient education. Cognitive and behavioral therapies as well as an interdisciplinary approach can be proposed for more complex or severe clinical situations, with a biopsychosocial vision of rehabilitation. To personalize the rehabilitation's therapeutic approach, a clinician can use simple and validated instruments for measuring physical performance that will highlight levels of physical conditioning, which range from low to very low in FM patients. Several systematic reviews and meta-analyses have found strong evidence that supervised aerobic and resistance-training programs reduce the pain intensity and significantly improve the quality of life and the physical and psychological functioning of female FM subjects. These therapeutic approaches appear safe and promising in terms of cost-effectiveness and should be the subject of more randomized controlled trials among male FM subjects and adolescents.

Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis

INTRODUCTION

Obesity has been associated with several complications, including musculoskeletal disorders. Aim of the present systematic review was to identify all available evidence on the relationship between fibromyalgia (FM) and obesity, including epidemiological association, impact of obesity on FM severity and effect of weight loss strategies on FM symptoms.

METHODS

MedLine, Cochrane Central Register of Controlled Trials and Web of Science databases were searched up to September 2020 to identify eligible articles. Data from studies reporting the prevalence of obesity in FM patients were pooled using a random-effects model.

RESULTS

After removal of duplicate records, 393 studies proceeded to review. A total of 41 articles were deemed eligible for inclusion in final synthesis. Quality assessment revealed that the overall risk of bias was high. The overall prevalence of obesity in FM was 35.7% (95% CI: 31.8 - 39.9%), with higher figures reported for USA. The majority of studies included demonstrated that obesity is associated with different domains of the disorder, including composite measures of activity, pain severity, tender point count, stiffness, fatigue, physical functioning/disability, sleep, cognitive dysfunction, and quality of life; the strength of correlation was weak on average. Inconsistent data were available regarding the correlation with depression and anxiety. Only few studies addressed the effect of therapeutic weight loss in FM, either by bariatric surgery, diet/exercise combination or behavioral weight loss, providing preliminary evidence for a potential benefit of weight loss in ameliorating FM symptoms.

CONCLUSIONS

Available data support a potential interplay between obesity and FM-related symptoms. Weight management should be encouraged in patients with FM.

Does work have to be so painful? A review of the literature examining the effects of fibromyalgia on the working experience from the patient perspective

Background

Chronic pain conditions, such as fibromyalgia, adversely affect individuals’ abilities to work.

Aim

The aim of this study was to examine, from the perspective of patients, the effects that fibromyalgia symptoms had on their ability to work, the challenges that they encountered in the workplace that did not foster their continued employment, and the types of modifications to their work or workplace that they thought would facilitate their productivity and ability to work.

Methods

A scoping review method, applying techniques of systematic review, was used to conduct a research synthesis of the literature regarding fibromyalgia and work that looked at this issue from the patient perspective.

Results

A variety of themes emerged from the analysis and could be broadly categorized into (1) the work experience was a challenging one with which to cope; (2) relationships were strained at work; (3) clinical symptoms had repercussions on subjects’ attitudes toward work and the relation to life outside of work; and (4) a variety of possible solutions were considered to help subjects better cope with fibromyalgia and work.

Conclusions

Strategies that potentially could foster continued employment of patients with fibromyalgia include those at the micro, meso, and macro levels. Health care providers can support patients’ employment goals by collaborating with patients and their employers, dispelling stigma regarding the illness, and providing practical and specific advice regarding workplace accommodations.

Comparative study of the effectiveness of a low-pressure hyperbaric oxygen treatment and physical exercise in women with fibromyalgia: randomized clinical trial

Background

Fibromyalgia (FM) is characterized by chronic pain and fatigue, among other manifestations, thus advising interventions that do not aggravate these symptoms. The main purpose of this study is to analyse the effect of low-pressure hyperbaric oxygen therapy (HBOT) on induced fatigue, pain, endurance and functional capacity, physical performance and cortical excitability when compared with a physical exercise program in women with FM.

Methods

A total of 49 women with FM took part in this randomized controlled trial. They were randomly allocated to three groups: physical exercise group (PEG, n = 16), low-pressure hyperbaric oxygen therapy group (HBG, n = 17) and control group (CG, n = 16). Induced fatigue, perceived pain, pressure pain threshold, endurance and functional capacity, physical performance and cortical excitability were assessed. To analyse the effect of the interventions, two assessments, that is, pre and post intervention, were carried out. Analyses of the data were performed using two-way mixed multivariate analysis of variance.

Results

The perceived pain and induced fatigue significantly improved only in the HBG (p < 0.05) as opposed to PEG and CG. Pressure pain threshold, endurance and functional capacity, and physical performance significantly improved for both interventions (p < 0.05). The cortical excitability (measured with the resting motor threshold) did not improve in any of the treatments (p > 0.05).

Conclusions

Low-pressure HBOT and physical exercise improve pressure pain threshold, endurance and functional capacity, as well as physical performance. Induced fatigue and perceived pain at rest significantly improved only with low-pressure HBOT.

Trial registration

ClinicalTrials.gov identifier NCT03801109.

Injuries and physical characteristics affecting swimmer participation in the Olympics: A prospective survey

OBJECTIVE

To identify injuries and physical characteristics affecting swimmers' performance.

DESIGN

Prospective study.

SETTING

Laboratory-based.

PARTICIPANTS

Sixty-four Rio Olympic candidates (36 men, 28 women), who were high level swimmers ranked among the top 32 in the 2014 World Ranking in swimming. The participants were categorized into the Olympian group (n = 25), swimmers who were consecutively selected for the Olympic team, and the non-Olympian group (n = 39), swimmers who were not.

MAIN OUTCOME MEASURES

Four months prior to the Olympic qualification in 2016, an orthopedist and two physical therapists evaluated injuries and 11 physical characteristics of the swimmers. The prevalence of total overuse injuries, shoulder and low back injury, and physical characteristics were compared between the two groups.

RESULTS

The female swimmers in the non-Olympian group had a 53.3% prevalence of total overuse injuries, which was significantly higher than that of those in the Olympian group with 15.4% (p = 0.037). The prevalence of total over use injuries in male swimmers in both the Olympian and non-Olympian groups was 41.7%. Female Olympian group showed that the shoulder external rotation range of motion was significantly less than that of non-Olympian group (97.8 ± 5.7 and 103.6 ± 7.3, p = 0.046).

CONCLUSIONS

In female swimmers, total overuse injuries four months before an important competition influence their performance at the event.

Associations of Cognitive Fusion and Pain Catastrophizing with Fibromyalgia Impact through Fatigue, Pain Severity, and Depression: An Exploratory Study Using Structural Equation Modeling

Differences in fibromyalgia impact on functioning exist and appear to be influenced by numerous factors, including symptomatology severity, as well as the cognitive profile of the individual. The contribution of these elements, however, tends to be explored in a fragmented manner. To address this issue, we tested a comprehensive structural equation model in which associations of cognitive fusion and pain catastrophizing with function limitations are investigated through fibromyalgia symptomatology (i.e., fatigue, pain severity, and depression) in 231 women with fibromyalgia. In the model, cognitive fusion and two catastrophizing components (magnification and helplessness) were associated with poorer functioning indirectly through fibromyalgia symptomatology. Only the rumination component of catastrophizing had a direct association with functional limitations. All fibromyalgia symptoms were linked to increased functional limitations. A parsimonious model with significant associations only obtained an excellent fit (S-B χ² = 774.191, df = 543, p < 0.001; CFI = 0.943; RMSEA = 0.043; CAIC = −2724.04) and accounted for 50% of the variance of functional limitations. These results suggest that the relationship between psychological cognitive processes, fibromyalgia symptomatology, and functional limitations is complex and support the need for comprehensive models such as the present. The findings are discussed in the context of personalized psychological treatments (i.e., the need to address certain cognitive processes according to the problematic symptomatology or outcome).

Low-Intensity Physical Exercise Improves Pain Catastrophizing and Other Psychological and Physical Aspects in Women with Fibromyalgia: A Randomized Controlled Trial

Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain and other physical and psychological features. In this study, we aimed to analyze the effect of a low-intensity physical exercise (PE) program, combining endurance training and coordination, on psychological aspects (i.e., pain catastrophizing, anxiety, depression, stress), pain perception (i.e., pain acceptance, pressure pain threshold (PPT), and quality of life and physical conditioning (i.e., self-perceived functional capacity, endurance and functional capacity, power and velocity) in women with FM. For this purpose, a randomized controlled trial was carried out. Thirty-two women with FM were randomly allocated to a PE group (PEG, n = 16), performing an eight-week low-intensity PE program and a control group (CG, n = 16). Pain catastrophizing, anxiety, depression, stress, pain acceptance, PPT, quality of life, self-perceived functional capacity, endurance and functional capacity, power, and velocity were assessed before and after the intervention. We observed a significant improvement in all studied variables in the PEG after the intervention (p < 0.05). In contrast, the CG showed no improvements in any variable, which further displayed poorer values for PPT (p < 0.05). In conclusion, a low-intensity combined PE program, including endurance training and coordination, improves psychological variables, pain perception, quality of life, and physical conditioning in women with FM.

Force-time curve features of handgrip strength in fibromyalgia syndrome

The aim of this study was to compare the handgrip strength (HGs), assessed with a cylindrical-shape grip device, of fibromyalgia syndrome (FM) patients with healthy subjects and to demonstrate the relationship between HGs characteristics and disease severity. Consecutive female patients with FM were enrolled and compared to a group of healthy women. The correlations between HGs curve characteristics and disease severity indices were studied through the Spearman’s rho correlation coefficients (rho). The HGs threshold distinguishing the FM presence was determined using the receiver operating characteristic (ROC) curves analysis. Multivariate regression analysis was used in order to assess the contribution of covariates on the HGs. 110 patients (mean age 53.8 ± 12.4 years) and 111 healthy controls have been enrolled. Altogether all parameters related to the analysis of HGs were worse in patients with FM. The HGs cut-off distinguishing the presence of a FM was 14.2 Kg. A negative correlation was found between disease severity indices and peak force (p < 0.001). Factors significantly associated with HGs area under the curve (AUC) in multivariate analysis were the Widespread Pain Index (WPI) (p = 0.003) and the revised Fibromyalgia Impact Questionnaire (FIQR) (p = 0.016). HGs is reduced in female FM patients and is inversely related to disease severity. The force-time curves analysis may be used as a complementary tool in the FM assessment and monitoring.

Strength Assessment Under Dual Task Conditions in Women with Fibromyalgia: A Test-Retest Reliability Study

The present study aimed to: (1) analyze the test-retest reliability of the 30 s chair stand test and the 30 s arm curl test under dual-task conditions; (2) analyze the test-retest reliability of a new variable which assesses the total performance (cognitive + physical) in both tests. A total of 37 women with fibromyalgia participated in the study. Participants completed the 30 s arm curl test and 30 s chair stand test in both simple and dual-task conditions. These tests were repeated after seven days. In the 30 s chair stand dual-task test the reliability was low to good whereas that of the total performance variable was low to moderate. The reliability in both the 30 s arm curl dual-task test and the total performance variable were good to moderate. Both the 30 s chair stand test and 30 s arm curl test under dual-task conditions and the total performance variables had good test-retest reliability. However, it is necessary to consider the fluctuations of the intraclass correlation coefficient (ICC).

High Levels of Physical Fitness Are Associated With Better Health-Related Quality of Life in Women With Fibromyalgia: The al-Ándalus Project

BACKGROUND

Physical fitness is a marker of health and is associated with health-related quality of life (HRQoL). Identifying which components of physical fitness are associated with HRQoL in people with fibromyalgia may contribute to the development of more specific therapeutic strategies.

OBJECTIVE

The 2 aims of this study were to examine the association of different components of physical fitness (ie, flexibility, muscle strength, speed and agility, and cardiorespiratory fitness) with HRQoL and to determine the extent to which any association between the components of physical fitness and HRQoL were of clinical relevance to women with fibromyalgia.

DESIGN

A cross-sectional design was used.

METHODS

This study included 466 women with fibromyalgia from southern Spain (Andalusia). The Senior Fitness Test battery and the handgrip test were used to assess physical fitness, and the 36-Item Short-Form Health Survey (SF-36) was used to assess HRQoL. Tender points, cognitive impairment, anthropometric measurements, and medication usage were also measured. First, multivariate linear regression was used to assess the individual relationship of each physical fitness test with the 8 dimensions of the SF-36. Second, a standardized composite score was computed for each component of physical fitness (flexibility, muscle strength, speed and agility, and cardiorespiratory fitness). A 1-way analysis of covariance to assess the differences in each of the 8 dimensions of the SF-36 across each physical fitness composite score was conducted. Forward stepwise regression was performed to analyze which components of physical fitness were independently associated with the SF-36 physical and mental component scales.

RESULTS

Overall, higher levels of physical fitness were associated with higher levels of HRQoL (regardless of the SF-36 subscale evaluated). The effect sizes for HRQoL between participants with the lowest and the highest physical fitness levels ranged from moderate to large (Cohen d = 0.53-0.90). The muscle strength composite score was independently associated with the SF-36 physical component scale, whereas the flexibility composite score and cardiorespiratory fitness were independently associated with the SF-36 mental component scale.

LIMITATIONS

A limitation was that the cross-sectional design precluded the establishment of causality. Additionally, only women were included in the study, because fibromyalgia predominantly affects women.

CONCLUSIONS

High levels of physical fitness were consistently associated with better HRQoL in women with fibromyalgia; clinically relevant differences were demonstrated between those at extreme physical fitness levels. Muscle strength, flexibility, and cardiorespiratory fitness were independent indicators of HRQoL. These results warrant further prospective research on the potential of fitness to predict HRQoL in this population.

Group Psychotherapy With Fibromyalgia Patients: A Systematic Review

Objectives

This review aims to investigate the factors that play a role on the efficacy of group psychotherapy (GP) interventions for fibromyalgia syndrome (FMS).

Materials and methods

We employed a search using keywords group psychotherapy and fibromyalgia in the databases of Scopus, Web of Sciences, CINAHL, BMJ, MEDLINE, ScienceDirect and EBSCOhost.

Results

A total of 30 original studies were identified. These studies, which aimed to improve primary outcomes (POs-pain and fibromyalgia impact) and/or secondary outcomes (SOs-psychosocial), indicated that 15 were conducted in a multidisciplinary (MT) fashion, and the rest were unidimensional as they employed only GPs. Cognitive behavior therapy, which modifies dysfunctional thoughts and accompanying behaviors, was the most utilized psychological intervention. Overall, MTs were only slightly superior to GPs; however, improvements in POs were more frequent than SOs in MTs, and the vice versa in GPs.

Conclusion

Although studies varied in various methodological characteristics, the content of the interventions in MTs should be designed to cover the biopsychosocial nature of FMS.

Effects of 24-week exergame intervention on physical function under single- and dual-task conditions in fibromyalgia: A randomized controlled trial

OBJECTIVE

To evaluate the effects of 24-week exergame intervention in the physical fitness of women with fibromyalgia in both single- and dual-task conditions.

DESIGN

Single-blinded, randomized controlled trial.

SETTING

University facilities.

PARTICIPANTS

Fifty-five women with fibromyalgia, recruited from the local fibromyalgia association, were randomly assigned to one of the two groups: exercise group and control group.

INTERVENTION

The exercise group completed 24 weeks of supervised and group-based exergame protocol, divided into two sessions of 60 minutes. The intervention was focused on mobility, postural control, upper and lower limbs coordination, aerobic fitness, and strength.

MAIN OUTCOME MEASURES

The strength of the upper limbs was measured using the arm curl test. The mobility skill was assessed through the timed-up and go test, and the flexibility of both upper and lower limbs was measured using the back scratch and the sit and reach tests, respectively.

RESULTS

Fifty participants completed the study. In the single-task condition, exergame intervention led to significantly higher effects in the arm curl test (P = 0.008), sit and reach test (P = 0.033), and timed-up and go test (P = 0.021). Moreover, under dual-task condition, exergames led to significant effects in all the physical fitness tests (arm curl test, timed-up and go test, back scratch test, and sit and reach test) compared to the control group.

CONCLUSIONS

Exergame is an effective tool to improve the physical fitness in women with fibromyalgia under single or dual-task conditions.

Reliability of the 30 s Chair Stand Test in Women with Fibromyalgia

Background: The 30 s chair stand test is often used to evaluate physical fitness in chronic pain populations. In patients with fibromyalgia, physical fitness is closely related to pain, quality of life, and fear of falling. However, the reliability of this test has only been evaluated concerning the number of repetitions. Objective: To evaluate the test–retest reliability of the 30 s chair stand test in women with fibromyalgia (n = 30), using data from the contact and non-contact time registered with an automatic chronometer (chronojump). Methods: Participants carried out the 30 s chair stand test twice with five minutes as a rest period, while an automatic chronometer recorded the time elapsed in contact with the chair (impulse phase) and not in contact (non-contact phase). Number and fear of falls in the last year and in the last six weeks were also recorded. Results: The reliability of duration of both phases was good. A relationship between these results and the number and fear of falling was also found. Conclusion: The analysis of movement phases in the 30 s chair stand test showed a good reliability in females with fibromyalgia, providing further useful information about the onset of muscle fatigue during the test.

Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial

Background

To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care.

Methods

An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model.

Results

After twelve months, there were no statistically significant differences between the intervention group (n = 60) and the control group (n = 61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p = 0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test.

Conclusions

No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome.

Trial registration

ClinicalTrials.gov: NCT02531282. Registered on August 212,015

Therapeutic validity of exercise interventions in the management of fibromyalgia

BACKGROUND

This study aimed to evaluate the therapeutic validity of exercise interventions included in a previous umbrella systematic review of high-quality randomized controlled trials (RCTs) in the management of fibromyalgia and to explore whether exercise interventions with high therapeutic validity and that meet the 2013 American College of Sports Medicine (ACSM) guidelines are positively associated with greater pain relief.

METHODS

Therapeutic validity was evaluated based on the CONsensus on Therapeutic Exercise and Training (CONTENT) Scale, in high methodological quality RCTs found in the nine systematic reviews of a previous umbrella review on exercise interventions in the management of fibromyalgia. Additionally, adherence to the 2013 ACSM exercise recommendations for fibromyalgia was analyzed. The effect size for pain relief after the exercise programs was also considered.

RESULTS

The CONTENT mean total score was 4.42 out of 9, demonstrating generally low therapeutic validity of the 28 included RCTs. There was poor concordance between therapeutic validity and pain relief (Kappa values ranging between -0.6 to 0.57). Kappa statistic results showed poor concordance (k=0.01) between statistically significant (P<0.05) pain relief values and adherence to the 2013 ACSM exercise recommendations.

CONCLUSIONS

The therapeutic validity of exercise intervention programs in fibromyalgia is low. This is mainly due to incomplete descriptions of exercise interventions and adherence. Poor concordance is found between high therapeutic validity and adherence to the ACSM exercise recommendations with pain relief. Improved standardized reporting is recommended to identify optimal exercise prescription for fibromyalgia.

Breathing Exercises Must Be a Real and Effective Intervention to Consider in Women with Fibromyalgia: A Pilot Randomized Controlled Trial

BACKGROUND/OBJECTIVE

Respiratory problems can aggravate pain located in the coincident areas with tender points in the upper half of the body in patients with fibromyalgia (FM) and easily become fatigued, thus can lead to a decrease in the functionality of daily activities. The purpose of this study was to examine the effects of a breathing exercises program on pain thresholds tolerance on tender points and FM impact on daily life.

METHODS/DESIGN

Thirty-five women with FM (age 34-67 years) were randomly assigned to an exercise group (n = 18), performing breathing exercises (30 min/session, 7 times/week; for 12 weeks), or to a control group (n = 17). Pain thresholds tolerance on tender points were measured by the physician using digital pressure algometer and FM impact on daily life was evaluated with the Portuguese version of the Fibromyalgia Impact Questionnaire (FIQ).

RESULTS

After 12 weeks of breathing exercises significant improvements were observed in the mean values of the treatment effects on pain thresholds tolerance on tender points and in the functional capacity to perform daily life, pain, and fatigue in favor of the exercise group. Gains in second rib, occiput, and supraspinatus pairs of the tender points predict improvements in the functional capacity, pain, and fatigue.

CONCLUSION

Our study demonstrated that breathing exercises produced relevant benefits on pain thresholds tolerance on tender points located in the upper half of the body, some of which predicted improvements in the impact of FM in the functional capacity to perform daily life, pain, and fatigue. These results provide further support of an idea that breathing exercises are a real and effective intervention to consider in women with FM.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN37081460, available information in www.isrctn.com/ ISRCTN37081460.

Stair negotiation in women with fibromyalgia: A descriptive correlational study

Walking up and down stairs is a common and important activity of daily living. Women with fibromyalgia often show a reduced ability to perform this task.The objective of this study was to evaluate the test-retest reliability of stair negotiation tasks and to assess the impact of fibromyalgia symptoms on the ability to negotiate stairs.Forty-two women with fibromyalgia participated in this descriptive correlational study. The relevance of the stair negotiation (both walking up and down) was evaluated by assessing its association with the revised version of the fibromyalgia impact questionnaire (FIQ-R) and other health-related variables. Test-retest reliability was also analyzed. The main outcome measures were time spent walking up and down stairs and impact of fibromyalgia, quality of life, number of falls, weight, and lower limb strength and endurance.The intraclass correlation coefficient (ICC) for stair descent was 0.929 whereas that for ascent was 0.972. The score in these tests correlated significantly with the total score for the FIQ-R and the score for many of dimensions and symptoms: that is, physical function, overall impact of fibromyalgia, pain, energy, stiffness, restorative sleep, tenderness, self-perceived balance problems, and sensitivity.Given the importance of the stair negotiation as activity of daily living and the high reliability, both stair ascent and descent tasks may be useful as outcome measures in studies on patients with fibromyalgia.

Impact of Fibromyalgia in the Sit-to-Stand-to-Sit Performance Compared With Healthy Controls

BACKGROUND

Fibromyalgia is associated with a reduction in the ability to perform activities of daily living. Sit-to-stand-to-sit performance is one of the most common activities of daily living and often is evaluated by counting the number of repetitions of the 30-second chair-stand test. No study, however, has examined the performance over the 30 seconds of this test of female patients with fibromyalgia on a phase-by-phase basis.

OBJECTIVE

To evaluate the impact of fibromyalgia on performance of the 30-second chair-stand test and to analyze how the kinematic performance changed over the 30-second test period.

DESIGN

A cross-sectional study.

SETTING

Local association of fibromyalgia.

PARTICIPANTS

Fifteen females with fibromyalgia and nine healthy female controls.

INTERVENTION

Participants performed the 30-second chair-stand test while wearing a motion capture device.

MAIN OUTCOME MEASURE

Duration of each sit-to-stand-to-sit phase within the 30-second time limit was compared between groups using repeated measures analysis of variance. The association between duration of phases and scores from the revised version of the Fibromyalgia Impact Questionnaire was tested using bivariate correlations.

RESULTS

The duration of impulse and sit-to-stand phases were gradually increased over the 30 seconds of the chair-stand test for women with fibromyalgia compared with healthy controls (P = .04 and P = .02, respectively). The mean duration of these 2 phases was associated with symptom duration and the function domain of the revised version of the Fibromyalgia Impact Questionnaire (P < .05). Also, stiffness was directly associated with the duration of the stand-up phase (P = .04).

CONCLUSION

Kinematic performance during the 30-second chair-stand test differed between women with fibromyalgia and healthy controls. Since sit-to-stand from a chair is a common daily activity, women with fibromyalgia may require specific exercises to improve performance of this task.

LEVEL OF EVIDENCE

Not applicable.

Physical fitness reference standards in fibromyalgia: The al-Ándalus project

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P < 0.001) in all age ranges (P < 0.001). This study provides a comprehensive description of age-specific physical fitness levels among patients with fibromyalgia and controls in a large sample of patients with fibromyalgia from southern of Spain. Physical fitness levels of people with fibromyalgia from Andalusia are very low in comparison with age-matched healthy controls. This information could be useful to correctly interpret physical fitness assessments and helping health care providers to identify individuals at risk for losing physical independence.

Perceived function and physical performance are associated with pain and fatigue in women with fibromyalgia

BACKGROUND

Fibromyalgia is a condition characterized by chronic widespread muscle pain and fatigue and associated with significant impairment in perceived function and reduced physical performance. The purpose of this study was to determine the degree to which pain and fatigue are associated with perceived function and physical performance in women with fibromyalgia.

METHODS

Hierarchical linear regression determined the contribution of pain and fatigue (Numeric Rating Scale (NRS) for resting, movement and combined) to perceived function (Fibromyalgia Impact Questionnaire Revised - Function Subscale, FIQR-Function), Multidimensional Assessment of Fatigue - Activities of Daily Living (MAF-ADL) and SF-36 Physical Function Subscale (SF-36-PF) and physical performance (6-Minute Walk Test, 6MWT and Five Time Sit To Stand, 5TSTS) while controlling for age, body mass index, pain catastrophizing, fear of movement, anxiety, and depression in women with fibromyalgia (N = 94).

RESULTS

For perceived function, movement pain and movement fatigue together better predicted FIQR-function (adjusted R(2) = 0.42, p ≤ 0.001); MAF-ADL (adjusted R(2) = 0.41, p ≤ 0.001); and SF-36-PF function (adjusted R(2) = 0.34, p ≤ 0.001). For physical performance measures, movement pain and fatigue together predicted 6MWT distance (adjusted R(2) = 0.42, p ≤ 0.001) and movement fatigue alone predicted performance time on the 5TSTS (adjusted R(2) = 0.20, p ≤ 0.001).

CONCLUSIONS

Pain and fatigue are significantly associated with and explain more than one-third of the variance in perceived function and physical performance in women with fibromyalgia.

TRIAL REGISTRATION

NIH Clinicaltrials.gov

REGISTRATION

NCT01888640 . Registered 13 June 2013.

Performance of women with fibromyalgia in walking up stairs while carrying a load

Background. Fibromyalgia is a chronic disease characterized by widespread pain and other associated symptoms. It has a relevant impact on physical fitness and the ability to perform daily living tasks. The objective of the study was to analyze the step-by-step-performance and the trunk tilt of women with fibromyalgia in the 10-step stair climbing test compared with healthy controls. Methods. A cross-sectional study was carried out. Twelve women suffering from fibromyalgia and eight healthy controls were recruited from a local association. Participants were asked to climb 10 stairs without carrying a load and 10 stairs carrying a load of 5 kg in each hand. Mediolateral trunk tilt was assessed using the "Functional Assessment of Biomechanics (FAB)" wireless motion capture device, and the time between steps was assessed via weight-bearing insoles. Results. Trunk tilt in the stair-climbing task carrying a load was significantly higher in women with fibromyalgia when compared to the healthy controls (2.31 (0.63) vs. 1.69 (0.51) respectively). The effect of carrying a load was significantly higher for women with fibromyalgia compared with healthy controls at the intermediate and final part of the task. Discussion. Trunk tilt during stair climbing while carrying a load was higher in women with FM, which could increase the risk of falling. Additionally, women with FM experienced a higher pace slowdown as a consequence of the load, which supports the need of including specific strength and resistance training to physical therapies for this population.

Association of cardiorespiratory fitness with pressure pain sensitivity and clinical pain in women with fibromyalgia

The aim of the present study was to assess the association of cardiorespiratory fitness (CRF) with pressure pain sensitivity and clinical pain in women with fibromyalgia (FM). Thirty-one women with FM were included in the study. Pressure pain sensitivity was assessed with an electronic pressure dolorimeter. The average pressure pain threshold (PPT) from the 18 FM-related tender points and the tender points count (TPC) were recorded. Clinical pain was assessed on a 10-cm visual analog scale (VAS; from the FM impact questionnaire). The patients performed an incremental treadmill test, which consisted in six increasing workloads. Gas exchange was continuously monitored, and peak oxygen uptake (as measure of CRF) was recorded. Pairwise correlation and multiple linear regression were used to examine the association of CRF with PPT and VAS, and binary logistic regression assessed the odds of having <18 positive tender points as a function of CRF. The correlations of CRF with the average PPT and VAS were 0.355, (P < 0.001) and 0.058 (P > 0.05), respectively. Regression analyses revealed that CRF was associated with the PPT (B = 0.093; 95 % CI 0.064-0.122; P < 0.001; R (2) = 0.306) and TPC (OR 1.51; 95 % CI 1.30-1.75; P < 0.001) but not with VAS (B = 0.068; 95 % CI -0.061-0.197; P > 0.05). The findings of this study suggest that CRF is associated with pressure pain sensitivity but not with clinical pain in women with FM. Further longitudinal and intervention studies are needed to determine whether CRF could be involved in some mechanisms of pain processing.

Cerebral responses to innocuous somatic pressure stimulation following aerobic exercise rehabilitation in chronic pain patients: a functional magnetic resonance imaging study

OBJECTIVE

The purpose of this research was to assess the functional brain activity and perceptual rating of innocuous somatic pressure stimulation before and after exercise rehabilitation in patients with chronic pain.

MATERIALS AND METHODS

Eleven chronic pain patients and eight healthy pain-free controls completed 12 weeks of supervised aerobic exercise intervention. Perceptual rating of standardized somatic pressure stimulation (2 kg) on the right anterior mid-thigh and brain responses during functional magnetic resonance imaging (fMRI) were assessed at pre- and postexercise rehabilitation.

RESULTS

There was a significant difference in the perceptual rating of innocuous somatic pressure stimulation between the chronic pain and control groups (P=0.02) but no difference following exercise rehabilitation. Whole brain voxel-wise analysis with correction for multiple comparisons revealed trends for differences in fMRI responses between the chronic pain and control groups in the superior temporal gyrus (chronic pain > control, corrected P=0.30), thalamus, and caudate (control > chronic, corrected P=0.23). Repeated measures of the regions of interest (5 mm radius) for blood oxygen level-dependent signal response revealed trend differences for superior temporal gyrus (P=0.06), thalamus (P=0.04), and caudate (P=0.21). Group-by-time interactions revealed trend differences in the caudate (P=0.10) and superior temporal gyrus (P=0.29).

CONCLUSION

Augmented perceptual and brain responses to innocuous somatic pressure stimulation were shown in the chronic pain group compared to the control group; however, 12-weeks of exercise rehabilitation did not significantly attenuate these responses.

Relationship between functional capacity and body mass index with plasma coenzyme Q10 and oxidative damage in community-dwelling elderly-people

The impact of aging and physical capacity on coenzyme Q10 (Q10) levels in human blood is unknown. Plasma Q10 is an important factor in cardiovascular diseases. To understand how physical activity in the elderly affects endogenous Q10 levels in blood plasma, we studied a cohort of healthy community-dwelling people. Volunteers were subjected to different tests of the Functional Fitness Test Battery including handgrip strength, six-minute walk, 30 s chair to stand, and time up and go tests. Anthropometric characteristics, plasma Q10 and lipid peroxidation (MDA) levels were determined. Population was divided according to gender and fitness. We found that people showing higher levels of functional capacity presented lower levels of cholesterol and lipid peroxidation accompanied by higher levels of Q10 in plasma. The ratio Q10/cholesterol and Q10/LDL increased in these people. No relationship was found when correlated to muscle strength or agility. On the other hand, obesity was related to lower Q10 and higher MDA levels in plasma affecting women more significantly. Our data demonstrate for the first time that physical activity at advanced age can increase the levels of Q10 and lower the levels of lipid peroxidation in plasma, probably reducing the progression of cardiovascular diseases.

Knee extensor strength is associated with pressure pain thresholds in adults with fibromyalgia

OBJECTIVE

Individuals with fibromyalgia (FM) have lower muscle strength and lower pressure pain thresholds (PPT). The primary aim of this study was to determine the associations between muscle strength and PPT in adults with FM to test the hypothesis that greater measures of muscle strength would be associated with greater values of PPT. Secondary aims included determining the effects of pain severity and the peak uptake of oxygen (VO2) on the associations between muscle strength and PPT.

METHODS

Knee extensor and flexor strength (N = 69) was measured in the dominant leg using a dynamometer, and PPT was assessed using an electronic algometer. Pain severity was determined using the Multidimensional Pain Inventory, and peak VO2 uptake was quantified using an electronically braked cycle ergometer.

RESULTS

Univariable linear regression analysis demonstrated a significant association between PPT (dependent variable) and isometric knee extensor (P<.001), isokinetic (60°/s) knee extensor (P = .002), and isokinetic (60°/s) knee flexor strength (P = .043). In a multiple variable linear regression analysis adjusted for age, sex, pain severity, body mass index and peak VO2 uptake, a significant association was found between PPT and isometric knee extensor strength (P = .008). In a similar multiple variable analysis, a significant association was found between PPT and isokinetic knee extensor strength (P = .044).

CONCLUSION

Greater measures of isometric and isokinetic knee extensor strength were significantly associated with greater values of PPT in both univariable and multiple variable linear regression models.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01253395.

Complementary and alternative exercise for fibromyalgia: a meta-analysis

Complementary and alternative medicine includes a number of exercise modalities, such as tai chi, qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature was conducted estimating the effect size of the different modalities, study quality and bias, and adverse events. The level of research has been moderately weak to date, but most studies report a medium-to-high effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these modalities as a critical component in a multimodal treatment plan, which is often required for fibromyalgia management.

Musculoskeletal fitness and health-related quality of life characteristics among sedentary office workers affected by sub-acute, non-specific low back pain: a cross-sectional study

OBJECTIVES

To establish the level of musculoskeletal fitness and health-related quality of life (HRQoL) in sedentary office workers with sub-acute, non-specific low back pain, and compare the results with reference data for healthy sedentary office workers.

DESIGN

Cross-sectional study.

SETTING

Occupational secondary prevention setting.

PARTICIPANTS

One-hundred and ninety sedentary office workers: 118 suffering from sub-acute, non-specific low back pain (47 men and 71 women) and 72 age-matched healthy controls (30 men and 42 women).

MAIN OUTCOME MEASURES

Participants were assessed using a musculoskeletal fitness battery (sit-and-reach test, hand grip strength, lumbar and abdominal trunk muscle endurance, and back scratch test), the EuroQol-5D-3L, Oswestry Disability Questionnaire, and Roland Morris Disability Questionnaire. Data for both genders and conditions were compared.

RESULTS

Subjects with low back pain achieved lower scores in most of the fitness tests compared with healthy, age-matched controls. Trunk flexor and extensor endurance demonstrated the greatest difference in both men {flexion: median difference 59 [95% confidence interval (CI) 26 to 90]seconds; extension: median difference 24 [95% CI 20 to 68]} and women [flexion: median difference 59 (95% CI 5 to 85.50)seconds; extension: median difference 41 (95% CI 30 to 55)seconds]. Differences in HRQoL were also demonstrated between groups for both men and women, with the exception of the pain/discomfort dimension in women.

CONCLUSIONS

Sedentary office workers with sub-acute, non-specific low back pain had lower musculoskeletal fitness than healthy, age-matched controls, with the main difference found in endurance of the trunk muscles. HRQoL was also lower in workers with low back pain.

Land- and water-based exercise intervention in women with fibromyalgia: the al-Andalus physical activity randomised controlled trial

Background

The al-Andalus physical activity intervention study is a randomised control trial to investigate the effectiveness of a land- and water-based exercise intervention for reducing the overall impact of fibromyalgia (primary outcome), and for improving tenderness and pain-related measures, body composition, functional capacity, physical activity and sedentary behaviour, fatigue, sleep quality, health-related quality of life, and cognitive function (secondary outcomes) in women with fibromyalgia.

Methods/Design

One hundred eighty women with fibromyalgia (age range: 35-65 years) will be recruited from local associations of fibromyalgia patients in Andalucía (Southern Spain). Patients will be randomly assigned to a usual care (control) group (n = 60), a water-based exercise intervention group (n = 60) or a land-based exercise intervention group (n = 60). Participants in the usual care group will receive general physical activity guidelines and participants allocated in the intervention groups will attend three non-consecutive training sessions (60 min each) per week during 24 weeks. Both exercise interventions will consist of aerobic, muscular strength and flexibility exercises. We will also study the effect of a detraining period (i.e., 12 weeks with no exercise intervention) on the studied variables.

Discussion

Our study attempts to reduce the impact of fibromyalgia and improve patients' health status by implementing two types of exercise interventions. Results from this study will help to assess the efficacy of exercise interventions for the treatment of fibromyalgia. If the interventions would be effective, this study will provide low-cost and feasible alternatives for health professionals in the management of fibromyalgia. Results from the al-Andalus physical activity intervention will help to better understand the potential of regular physical activity for improving the well-being of women with fibromyalgia.

Trial registration

ClinicalTrials.gov ID: NCT01490281