Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study

Physical activity correlates in people with fibromyalgia: a systematic review

PURPOSE

Understanding the enablers of and barriers to physical activity (PA) participation in people with fibromyalgia (PwF) is an essential first step to developing effective PA interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental, and policy level) in PwF.

MATERIALS AND METHODS

PubMed, Embase, and CINAHL were searched from inception until 12 July 2022. Keywords included "physical activity" or "exercise" and "fibromyalgia" or "fibrositis." Summary coding was used to quantify the PA correlates.

RESULTS

Out of 74 PA correlates retrieved from 39 articles (n = 9426), co-morbid depression and higher pain intensity were found to be consistent (i.e., reported in four or more articles) barriers to PA in PwF, while higher self-efficacy and better endurance were found to be consistent enablers to PA. Despite the abundance of evidence for the PA benefits for PwF, we only found consistent evidence for PA correlates at the intrapersonal level.

CONCLUSIONS

Health professionals should consider mental and physical health barriers when promoting PA in PwF. There remains a need to better understand social, environmental, and policy-related factors associated with PA participation in PwFImplications for rehabilitationCo-morbid depression is a notable barrier to physical activity participation in people with fibromyalgia.Experienced pain intensity should be considered as a barrier when promoting physical activity for people with fibromyalgia.Rehabilitation professionals should facilitate self-efficacy in physical activity interventions for people with fibromyalgia.Rehabilitation professionals should promote endurance when motivating people with fibromyalgia towards an active lifestyle.

Correlates of sedentary behavior in people with fibromyalgia: A systematic review

INTRODUCTION

Understanding the correlates of sedentary behavior (SB) is important in the development of interventions which reduce and interrupt SB in people with fibromyalgia (PwF). This systematic review aimed to investigate the correlates of SB in PwF using the socio-ecological model.

METHODS

Three databases (Embase, CINAHL and PubMed) were search from inception until July 21, 2022 using "sedentary" or different types of SB and "fibromyalgia" or "fibrositis" as keywords. The data collected was then analyzed using summary coding.

RESULTS

Out of 23 SB correlates retrieved from 7 reports (n = 1698), no correlates were consistently reported (ie, reported in 4 or more studies). Higher pain intensity was the most commonly reported barrier for reducing/interrupting SB (reported in 3 reports). Other reported barriers to reducing/interrupting SB were experiencing physical and mental fatigue, a more severe disease impact, and a lack of motivation to be physically active (all reported in 1 study). A better experienced social and physical functioning and more vitality were facilitators for reducing/interrupting SB (all reported in 1 study). To date, in PwF no correlates of SB at the interpersonal, environmental and policy levels have been explored.

CONCLUSION

Research on correlates of SB in PwF is still in its infancy. The current preliminary evidence suggests that clinicians should consider physical and mental barriers when aiming to reduce or interrupt SB in PwF. Further research on modifiable correlates at all levels of the socio-ecological model is required to inform future trials aiming to modify SB in this vulnerable population.

Physical activity assessment with wearable devices in rheumatic diseases: a systematic review and meta-analysis

OBJECTIVES

In the management of rheumatic musculoskeletal disorders (RMDs), regular physical activity (PA) is an important recognized non-pharmacological intervention. This systematic review and meta-analysis aims to evaluate how the use of wearable devices (WDs) impacts physical activity in patients with noninflammatory and inflammatory rheumatic diseases.

METHODS

A comprehensive search of articles was performed in PubMed, Embase, CINAHL and Scopus. A random-effect meta-analysis was carried out on the number of steps and moderate-vigorous physical activity (MVPA). Univariable meta-regression models were computed to assess the possibility that the study characteristics may act as modifiers on the final meta-analysis estimate.

RESULTS

In the analysis, 51 articles were included, with a total of 7488 participants. Twenty-two studies considered MVPA outcome alone, 16 studies considered the number of steps alone, and 13 studies reported information on both outcomes. The recommended PA threshold was reached for MVPA (36.35, 95% CI 29.39, 43.31) but not for daily steps (-1092.60, -1640.42 to -544.77). Studies on patients with fibromyalgia report a higher number (6290, 5198.65-7381.62) of daily steps compared with other RMDs. Patients affected by chronic inflammatory arthropathies seemed to fare better in terms of daily steps than the other categories. Patients of younger age reported a higher overall level of PA than elderly individuals for both the number of steps and MVPA.

CONCLUSION

Physical activity can be lower than the recommended threshold in patients with RMDs when objectively measured using WD. WDs could be a useful and affordable instrument for daily monitoring physical activity in RMDs and may support an increase in activity levels.

PROSPERO TRIAL REGISTRATION

CRD42021227681, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227681.

Effects of strength training in fibromyalgia on balance, neuromuscular performance, and symptomatic analysis: a 12-week study protocol

Fibromyalgia affects skeletal muscles presenting with muscle stiffness, pain, and fatigue. The exercise practice is wellstabilized and suggested for the reduction of symptoms. However, there are some gaps in the literature related to balance and neuromuscular performance in a strength training protocol. The aim of this study is to structure a protocol to verify the effects of strength training applied over a short period, on balance, neuromuscular performance, and fibromyalgia symptoms. Additionally, we intend to analyze the effects of a short period of cessation of training. Participants will be recruited through flyers, internet advertisements, clinical referrals, health professionals, and email outreach. Volunteers will be randomly assigned to the control group or experimental group. Before the training period, symptoms (Fibromyalgia Impact Questionnaire, Visual Analog Scale), balance (force plate), and neuromuscular performance (medicine ball throw and vertical jump) will be assessed. Participants in the experimental group will perform strength training twice a week (50 min each), on alternate days, for 8 weeks (16 sessions). Then, 4 weeks of detraining will be completed. This training program will be carried out online, using real-time videos, and the participants will be divided into two groups with different schedules. The Borg scale will be used to monitor perceived effort in each session. There is a gap in the literature about exercise prescriptions for fibromyalgia. The supervised online intervention enables a wide range of participation. The strength exercises used (without the use of external materials and/or machines) and load (few repetitions per set) represent a novelty to training programming. Moreover, this training program respects the limitations and individuality of the volunteers, providing exercise adaptations. With positive results, the present protocol could be an easy-to-apply guideline with clear instructions on the details related to exercise prescription. Also, ensure the effectiveness of a low-cost and feasible treatment, especially for fibromyalgia patients.

Clinical trial registration

https://clinicaltrials.gov/, identifier: NCT05646641.

Decline in skeletal muscle mass is associated with cognitive decline in type 2 diabetes mellitus

AIMS

To examine the longitudinal association between skeletal muscle mass (SMM) loss and cognitive decline over time in type 2 diabetes mellitus (T2DM).

METHODS

We conducted a prospective cohort study of 453 patients from SMART2D cohort with follow-up intervals of 1.6 to 6.4 years. Baseline and follow-up measurements included bio-impedance analysis (BIA) measure of skeletal muscle mass index (SMI) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) measure of cognitive function. We examined the association between annual rate of SMI and RBANS scores using linear regression, adjusting for demographics, education, depression, clinical co-variables and presence of apolipoprotein E4 (APOE) _Ɛ4 allele.

RESULTS

The mean age of participants was 60.3 ± 7.4 years. Compared to patients with Tertile 1 SMI change, the group with greater SMI decline (Tertile 3 SMI change) experienced 0.30 decline in RBANS total score (95%CI -0.57 to -0.03; p = 0.030) in the adjusted analysis. RBANS scores for subdomains in immediate memory and visuo-spatial/construction were lower in Tertile 3 SMI change group with corresponding coefficients -0.54 (95%CI -1.01 to -0.06; p = 0.026), and -0.71 (95%CI -1.30 to -0.12; p = 0.019) respectively.

CONCLUSION

In patients with T2DM, BIA measure of muscle mass loss over time was independently associated with cognitive decline globally and in the domains of memory and visuo-spatial/construction.

Are There Interindividual Differences in Anxiety as a Result of Aerobic Exercise Training in Adults With Fibromyalgia? An Ancillary Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To determine whether true interindividual response differences (IIRD) exist with respect to changes in anxiety because of aerobic exercise training in adults with fibromyalgia (FM).

DATA SOURCES

Data from a previous meta-analytical database of randomized controlled trials of exercise in adults with arthritis and other rheumatic diseases.

STUDY SELECTION

Randomized controlled trials limited to aerobic exercise training on anxiety in adults 18 years or older with FM were included.

DATA EXTRACTION

Change outcome SDs treated as point estimates for anxiety were used to calculate true IIRD from each study. In addition, treatment effect data were extracted.

DATA SYNTHESIS

The inverse variance heterogeneity model was used to pool all results. For the 5 studies and 321 participants in which results were pooled, statistically significant treatment effect reductions in anxiety were observed (mean, -0.77 points, 95% CI, -1.25 to -0.77). However, no significant IIRD were found (mean, 0.6 points, 95% CI, -1.2 to 1.5). The 95% prediction interval for true IIRD in a future study was -1.7 to 0.8. The percent chance, ie, probability, of a clinically meaningful difference in variability, was 61.5% (only possibly clinically important).

CONCLUSIONS

The results of the current study suggest that aerobic exercise is associated with reductions in anxiety among adults with fibromyalgia. However, there is currently a lack of convincing evidence to support the notion that true IIRD exist. Therefore, a search for potential mediators and moderators associated with aerobic exercise and changes in anxiety among adults with FM may not be warranted. However, additional research is needed before any true level of certainty can be established. This includes (1) the assessment of IIRD in future randomized controlled trials, (2) randomized controlled trials of longer duration, and (3) an increase in the proportion of men included in randomized controlled trials.

Amino acid profile of skeletal muscle loss in type 2 diabetes: Results from a 7-year longitudinal study in asians

AIMS

Little is known about pathophysiology of sarcopenia in diabetes. We aimed to study amino acid profile associated with skeletal muscle mass loss longitudinally in Type 2 Diabetes Mellitus (T2DM).

METHODS

This is a prospective study of 1140 patients aged 56.6 ± 10.6 years from the SMART2D cohort. Skeletal muscle mass was measured using bio-impedance analysis at baseline and follow-up. Amino acids were measured by mass spectrometry.

RESULTS

Over a period of up to 7.9 years, 43.9% experienced skeletal muscle mass loss. Lower baseline valine, leucine and isoleucine levels were associated with decreased skeletal muscle mass index (SMI) with corresponding coefficient 0.251(95 %CI 0.009 to 0.493), 0.298(95 %CI 0.051 to 0.544)) and 0.366(95 %CI 0.131 to 0.600). Higher baseline valine, leucine, isoleucine, alanine and tryptophan levels were associated with reduced odds of muscle mass loss with corresponding odds ratio (OR)0.797 (95 %CI 0.690 to 0.921), 0.825 (95 %CI 0.713 to 0.955), 0.826 (95 %CI 0.718-0.950), 0.847 (95 %CI 0.739-0.969) and 0.835 (95 %CI 0.720-0.979).

CONCLUSION

The branched-chain amino acids valine, leucine and isoleucine were positively associated with change in SMI and reduced odds of muscle mass loss longitudinally. Further studies should be conducted to elucidate the pathophysiological mechanisms underlying the relationship between these amino acids and muscle mass loss in T2DM.

Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

Motivational Determinants of Objective Physical Activity in Women with Fibromyalgia Who Attended Rehabilitation Settings

Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.

Characteristics Associated With People With Chronic Low Back Pain Meeting Physical Activity Guidelines and Recommendations for Sedentary Behavior: A Cross-Sectional Study

OBJECTIVE

The purpose of this study was to identify factors associated with meeting physical activity guidelines and sedentary recommendations in people with chronic low back pain (LBP).

METHODS

This was a cross-sectional study including 171 people with chronic LBP. Trained assessors collected information regarding demographic, anthropometric, and clinical data. Physical activity levels and sedentary time were objectively measured using a tri-axial accelerometer. Participants were classified as being physically active (ie, performing at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week) and sedentary (ie, more than 8 hours of time spent in sedentary activities per day). Multivariable logistic regression analyses were used to determine the association of being physically active or sedentary with the range of demographic, anthropometric and clinical variables.

RESULTS

Our results showed that although lower body mass index (odds ratio [OR] = 0.91; 95% CI: 0.85-0.98) and higher self-reported levels of leisure time physical activity (OR = 3.46; 95% CI: 1.94-6.15) were associated with being physically active, lower self-reported levels of physical activity at work (OR = 0.56; 95% CI: 0.39-0.81) was associated with being sedentary.

CONCLUSION

Our findings showed that, in people with LBP, lower body mass index and higher levels of leisure time physical activity may be important factors for identifying those physically active. In contrast, lower levels of physical activity at work may be considered when identifying sedentary people with LBP. Future studies should consider these factors when designing interventions aiming to promote physical activity and decrease sedentary behavior in this population.

Low muscle mass is associated with progression of chronic kidney disease and albuminuria - An 8-year longitudinal study in Asians with Type 2 Diabetes

AIMS

We examined the longitudinal relationship between baseline skeletal muscle mass and its change over time with eGFR decline and albuminuria progression among Asians with type 2 diabetes(T2D).

METHODS

This was a prospective cohort study of 1272 T2D patients. Skeletal muscle mass was estimated using tetra-polar multi-frequency bio-impedance analysis and Skeletal Muscle Mass Index(SMI) was defined as skeletal muscle mass/weight * 100.

RESULTS

After up to 8 years of follow-up, 33.3% of participants had CKD progression and 28.3% albuminuria progression. Every 1-SD above baseline SMI was associated with 18% lower risk of CKD progression[Hazards Ratio(HR)0.82; 95%CI 0.70-0.97; p = 0.018] and 17% lower risk of albuminuria progression [HR 0.83 (95%CI 0.71-0.97; p = 0.017)]. The largest decrease in SMI over time was associated with 67% higher risk of CKD progression, compared to those with the smallest change from baseline SMI tertile 2[HR 1.67 (95%CI 1.10-2.55); p = 0.016]. Pigment epithelium-derived factor(PEDF) and plasma leucine-rich α-2-glycoprotein (LRG1) accounted for 40.1% of the association between SMI and CKD progression.

CONCLUSIONS

Low baseline skeletal muscle mass and its reduction over time is associated with increased risk of progression of CKD among Asians with T2D. PEDF and LRG1 mediated the inverse relationship between SMI and CKD progression.

Association between Lower Extremity Skeletal Muscle Mass and Impaired Cognitive Function in Type 2 Diabetes

Lower extremity skeletal muscle mass (LESM) in Type 2 Diabetes (T2D) has been linked to adverse clinical events, but it is not known whether it is associated with cognitive difficulties. We conducted a cross-sectional study on 1,235 people (mean age 61.4 ± 8.0 years) with T2D under primary and secondary care in Singapore. Bioelectrical impedance analyses (BIA) measures of upper extremity skeletal muscle mass (UESM), LESM and appendicular skeletal muscle index (SMI) were related to the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) measures of cognition, in multiple linear regression. In multivariable models, tertile 1 LESM (b = −2.62 (−3.92 to −1.32)) and tertile 2 LESM (b = −1.73 (−2.73 to −0.73)), referenced to tertile 3) were significantly associated with decreased RBANS total score. Significant associations of LESM with cognitive domain performances were observed for tertile 1 (b = −3.75 (−5.98 to −1.52)) and tertile 2 (b = −1.98 (−3.69 to −0.27)) with immediate memory, and for tertile 1 (b = −3.05 (−4.86 to −1.24)) and tertile 2 (b = −1.87 (−3.25 to −0.48)) with delayed memory, and for tertile 1 (b = −2.99 (−5.30 to −0.68)) with visuospatial/constructional ability. Tertile 1 SMI (b = −1.94 (−3.79 to −0.08) and tertile 2 SMI (b = −1.75 (−3.14 to −0.37)) were also associated with delayed memory. There were no associations between UESM with cognitive performance. Lower LESM may be a useful marker of possible co-occuring cognitive dysfunction.

Measuring Sedentary Behavior During Pregnancy: Comparison Between Self-reported and Objective Measures

Objectives To quantify and compare the sedentary time estimated by the Sedentary Behavior Questionnaire (SBQ) and the sedentary time objectively measured by a multi-sensor monitor (SWA) in pregnant women. Methods One hundred eighty-six participants answered the SBQ and wore the SWA at least 7 valid days. The concordance, correlation, agreement and relative activity levels between both measures of sedentary time were examined. Differences of sedentary time between weekday and weekend and between groups stratified by sociodemographic and clinical characteristic were evaluated by one-way analysis of variance. Results Pregnant women were sedentary the 64% of their waking hours. Television viewing is the most prevalent sedentary behavior. The concordance, correlation, and agreement between SBQ and SWA were weak, yet a significant correlation in weekday and average day sedentary time (r = 0.23 and 0.20, P = 0.001 and 0.008, respectively) was observed. A significant linear trend was found for increasing sedentary time between both methods using a relative activity levels analysis. Conclusions for Practice Pregnant women experience high amount of sedentary time, for approximately half of the day. The SBQ shows a low validity and agreement, but strong ability to rank individuals compared with SWA in pregnant women.

Disentangling the relationship between sedentariness and obesity: Activity intensity, but not sitting posture, is associated with adiposity in women

BACKGROUND

The relationship between free-living sedentary behaviour (SB) and obesity is unclear. Studies may arrive at disparate conclusions because of inconsistencies and limitations when defining and measuring free-living SB. The aim of this cross-sectional study was to examine whether the relationship between SB and adiposity differed depending on the way SB was operationally defined and objectively measured.

METHODS

Sixty-three female participants aged 37.1 years (SD = 13.6) with a body mass index (BMI) of 29.6 kg/m² (SD = 4.7) had their body composition measured (BodPod, Concord, CA) then were continuously monitored for 5-7 days with the SenseWear Armband (SWA; sleep and activity intensity) and the activPAL (AP; posture). Data from both activity monitors were analysed separately and integrated resulting in a third measure of SB (activity intensity and posture; SED^INT). SB outputs were compared according to week or weekend day averages then correlated against body composition parameters after adjusting for moderate-to-vigorous physical activity (MVPA).

RESULTS

SED^SWA resulted in the most sedentary time 11.74 h/day (SD = 1.60), followed by SED^AP 10.16 h/day (SD = 1.75) and SED^INT 9.10 h/day (SD = 1.67). There was a significant positive association between SED^SWA and body mass [r(61) = 0.29, p = .02], BMI [r (61) = 0.33, p = .009] and fat mass [r(61) = 0.32, p = .01]. SED^AP and SED^INT were not associated with any of the indices of adiposity. Correlations between SB and adiposity were non-significant when controlling for MVPA.

CONCLUSIONS

The relationship between SB and adiposity differed depending on how SB was operationally defined and measured, and was dependent on MVPA. The definition of SB based on a sitting posture (SED^AP) was not strongly related to body fat, whereas the accumulation of any behaviour (sitting or standing) with an intensity of <1.5 METs (SED^SWA) (offset by the presence of MVPA) was positively associated with indices of adiposity. These data suggest that the postural element of SB (sitting) is not sufficient for the accumulation of adiposity, rather activities requiring low EE (<1.5 METs) and the absence of MVPA, regardless of posture, are associated with higher fat mass.

Correlates of sedentary behaviour in adults: a systematic review

OBJECTIVE

The objective of this study was to systematically review evidence to identify intrapersonal, social environmental, physical environmental and policy correlates of sedentary behaviour (SB) among adults.

METHODS

Six databases were searched to identify studies that reported on intrapersonal, social, physical environmental and/or policy correlates of SB across domains (i.e. occupational, leisure and transportation) in adults (mean ≥ 18 years old). Subgroup differences (sex, age, disease status, publication status and date, weekdays vs. weekend) were examined. Risk of bias was assessed, and a qualitative synthesis completed.

PROSPERO

CRD42014009814 RESULTS: Searching identified 22,779 articles; 257 were used in the analysis. Most studies used self-reported SB and were cross-sectional. The most studied domain of SB and correlate was leisure and intrapersonal, respectively. Consistent evidence found positive relationships between full-time employment and higher transportation and lower leisure SB; higher income/socioeconomic status and greater transportation and occupation SB; living in more urban areas and greater sitting time and total SB; ownership of televisions and greater leisure SB; and, active workstations and lower occupational SB.

CONCLUSIONS

The review identifies the need for longitudinal studies, as well as further research on factors in the physical, social and policy environments. The review also recognizes the need to standardize methodology for collecting, defining and reporting SB and correlates.

Physical inactivity and sedentary behavior: Overlooked risk factors in autoimmune rheumatic diseases?

This review aims to (1) summarize the estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases; (2) describe the relationship between physical (in)activity levels and disease-related outcomes; (3) contextualize the estimates and impact of physical inactivity and sedentary behavior in autoimmune diseases compared to other rheumatic diseases and chronic conditions; and (4) discuss scientific perspectives around this theme and potential clinical interventions to attenuate these preventable risk factors. We compiled evidence to show that estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases are generally comparable to other rheumatic diseases as well as to other chronic conditions (e.g., type 2 diabetes, cardiovascular diseases, and obesity), in which a lack of physical activity and excess of sedentary behavior are well-known predictors of morbimortality. In addition, we also showed evidence that both physical inactivity and sedentary behavior may be associated with poor health-related outcomes (e.g., worse disease symptoms and low functionality) in autoimmune rheumatic diseases. Thus, putting into practice interventions to make the patients "sit less and move more", particularly light-intensity activities and/or breaking-up sedentary time, is a simple and prudent therapeutic approach to minimize physical inactivity and sedentary behavior, which are overlooked yet modifiable risk factors in the field of autoimmune rheumatic diseases.

Sleep Quality and Body Composition Variations in Obese Male Adults after 14 Weeks of Yoga Intervention: A Randomized Controlled Trial

Background:

Obesity is a big challenge all over the world. It is associated with many noncommunicable diseases. Yoga known to be add-on treatment may be effective for obesity control.

Aim:

To assess the effect of integrated approach of yoga therapy (IAYT) for body composition and quality of sleep in adult obese male.

Subjects and Methods:

A randomized controlled trial was conducted for 14 weeks on obese male of urban setting. Eighty individuals were randomly divided into two groups, i.e., yoga group (n = 40; age; 40.03 ± 8.74 years, body mass index [BMI] 28.7 ± 2.35 kg/m²) and control group (age; 42.20 ± 12.06 years, BMI 27.70 ± 2.05 kg/m²). The IAYT was imparted to yoga group for 1½ hour for 5 days in a week for 14 weeks. The control group continued their regular activities. The body composition by InBody R20 and sleep quality by Pittsburgh Sleep Quality Index (PSQI) were assessed. Statistical analysis was done for within and between groups using SPSS version 21. The correlation analysis was done on the difference in pre-post values.

Results:

The results showed that weight (P = 0.004), BMI (P = 0.008), bone mass (P = 0.017), obesity degree (P = 0.005), and mineral mass (P = 0.046) were improved in yoga group and no change in control group (P > 0.05). The global score of PSQI improved (P = 0.017) in yoga group alone.

Conclusion:

The results indicate the beneficial effects of IAYT on body composition and sleep quality in obese males. The yoga practice may reduce obesity with the improvement in quality of life.

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.

Walking Beliefs in Women With Fibromyalgia: Clinical Profile and Impact on Walking Behavior

Although exercise is essential for the treatment of fibromyalgia, adherence is low. Walking, as a form of physical exercise, has significant advantages. The aim of this article is to describe, in 920 women with fibromyalgia, the prevalence of certain walking beliefs and analyze their effects both on the walking behavior itself and on the associated symptoms when patients walk according to a clinically recommended way. The results highlight the high prevalence of beliefs related to pain and fatigue as walking-inhibitors. In the whole sample, beliefs are associated with an increased perception that comorbidity prevents walking, and with higher levels of pain and fatigue. In patients who walk regularly, beliefs are only associated with the perception that comorbidity prevents them from walking. It is necessary to promote walking according to the established way (including breaks to prevent fatigue) and to implement interventions on the most prevalent beliefs that inhibit walking.

Patients With Fibromyalgia Have Significant Autonomic Symptoms But Modest Autonomic Dysfunction

BACKGROUND

Research suggests that disordered autonomic function may be one contributor to deconditioning reported in fibromyalgia; however, no study to date has assessed these variables simultaneously with comprehensive measures.

OBJECTIVE

To characterize physical fitness and autonomic function with the use of clinically validated measures and subjective questionnaires between patients with fibromyalgia and healthy controls.

DESIGN

Cross-sectional, observational, controlled study.

SETTING

Community sample of patients with fibromyalgia and healthy controls.

PARTICIPANTS

Thirty patients with fibromyalgia and 30 pain and fatigue-free controls.

METHODS

Participants completed a battery of self-report questionnaires and physiological measures, including clinically validated measures of physical fitness and autonomic function.

MAIN OUTCOME MEASUREMENTS

Six-Minute Walk Test total distance, maximal oxygen consumption as assessed by cardiopulmonary exercise testing, total steps using activity monitor, Composite Autonomic Scoring Scale as assessed by Autonomic Reflex Screen, total metabolic equivalents per week using the International Physical Activity Questionnaire, and self-reported autonomic symptoms via the 31-item Composite Autonomic Symptom Score questionnaire.

RESULTS

Autonomic function, as assessed by self-report, was significantly different between patients and controls (P < .0001); in contrast, the only difference between patients and controls on the Autonomic Reflex Screen was in the adrenergic domain (P = .022), and these abnormalities were mild. Self-reported physical activity was not significantly different between patients and controls (P = .99), but levels of moderate and vigorous physical activity as measured by actigraphy were significantly lower in patients (P = .012 and P = .047, respectively). Exercise capacity (6-Minute Walk) was poorer in patients (P = .0006), but there was no significant difference in maximal volume of oxygen consumption (P = .07).

CONCLUSIONS

Patients with fibromyalgia report more severe symptoms across all domains, including physical activity and autonomic symptoms, compared with controls, but the objective assessments only showed modest differences. Our results suggest that patients with widespread subjective impairment of function have only modest objective measures of autonomic dysfunction. We recommend that the primary treatment goal should be focused on restoration of function, which may also ameliorate symptoms.

Exercise Strengthens Central Nervous System Modulation of Pain in Fibromyalgia

To begin to elucidate the mechanisms underlying the benefits of exercise for chronic pain, we assessed the influence of exercise on brain responses to pain in fibromyalgia (FM). Complete data were collected for nine female FM patients and nine pain-free controls (CO) who underwent two functional neuroimaging scans, following exercise (EX) and following quiet rest (QR). Brain responses and pain ratings to noxious heat stimuli were compared within and between groups. For pain ratings, there was a significant (p < 0.05) Condition by Run interaction characterized by moderately lower pain ratings post EX compared to QR (d = 0.39–0.41) for FM but similar to ratings in CO (d = 0.10–0.26), thereby demonstrating that exercise decreased pain sensitivity in FM patients to a level that was analogous to pain-free controls. Brain responses demonstrated a significant within-group difference in FM patients, characterized by less brain activity bilaterally in the anterior insula following QR as compared to EX. There was also a significant Group by Condition interaction with FM patients showing less activity in the left dorsolateral prefrontal cortex following QR as compared to post-EX and CO following both conditions. These results suggest that exercise appeared to stimulate brain regions involved in descending pain inhibition in FM patients, decreasing their sensitivity to pain. Thus, exercise may benefit patients with FM via improving the functional capacity of the pain modulatory system.

Sarcopenic obesity and physical performance in middle aged women: a cross-sectional study in Northeast Brazil

BACKGROUND

Sarcopenia and obesity have been independently associated with physical function decline, however little information is currently available on the relationship between sarcopenic obesity and physical performance, mainly in middle aged women. The present study aims to estimate the prevalence of sarcopenic obesity and to explore the relationship between sarcopenic obesity and physical performance in middle-aged women from Northeast Brazil.

METHODS

A cross-sectional study of women (40-65 years) living in Parnamirim, a city in Northeast Brazil (n = 491). Physical performance was assessed by grip strength, knee extensor and flexor strength (isometric dynamometry), gait speed, and chair stands. Using bioelectrical impedance analysis (BIA), appendicular skeletal muscle mass divided by height squared (kg / m(2)) was used to define sarcopenia. Waist circumference ≥ 88 cm was defined as abdominal obesity. Sarcopenic obesity was defined as the coexistence of obesity and sarcopenia. The physical performance outcomes were regressed in four groups defined by combinations of sarcopenia and obesity, adjusting for potential confounders (age, education and menopausal status).

RESULTS

Prevalence rates of the four obesity-sarcopenia groups were: Sarcopenic obesity (7.1 %), obesity (67.4 %), sarcopenia (12.4 %) and normal (13 %). Women with sarcopenic obesity had significantly lower grip strength, weaker knee extension and flexion and longer time to raise from a chair compared with non-obese and non-sarcopenic women (p.values < 0.001). Except for the chair stands, these statistically significant differences were also found between sarcopenic obese and obese women. There was no significant difference for gait speed across the four groups (p = 0.50).

CONCLUSION

Sarcopenic obesity was present in 7 % of this population of middle-aged women from Northeast Brazil and it was associated with poor physical performance. Sarcopenic obesity may occur in middle-aged women with performance limitations beyond pure sarcopenia-related muscle mass or obesity alone.

A New Rehabilitation Tool in Fibromyalgia: The Effects of Perceptive Rehabilitation on Pain and Function in a Clinical Randomized Controlled Trial

Introduction/Objective. Fibromyalgia might benefit from a specific tactile and proprioceptive rehabilitation approach. The aim of this study was to perform a randomized controlled trial to determine the efficacy of perceptual surfaces (PS) and physical exercises with regard to chronic pain and physical function in fibromyalgia compared with a control group. Methods. Data from 54 females (18–60 years old) with a diagnosis of fibromyalgia and scoring >5 on the visual analog scale were divided into 3 groups and analyzed: group treated with perceptual surfaces (PS-group), physical exercises group (PE-group), and control group (CG). The Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Fibromyalgia Assessment Scale (FAS) were administered at baseline (T0), at the end of the treatment (T1) (after 10 rehabilitation sessions over a 5-week period), and at the 12-week follow-up (T2). Results. The PS-group experienced a statistically significant improvement versus the CG in FAS and HAQ scores. Good efficacy with respect to pain and function in the PE-group compared with the CG in terms of FAS, HAQ, and FIQ scores was observed. The adherence ratio was 86% for the PE-group and CG and 90% for the PS-group. Conclusions. According to the results, the PS are as promising as the physical exercises, since results were similar.

Comparison of physical activity using questionnaires (leisure time physical activity instrument and physical activity at home and work instrument) and accelerometry in fibromyalgia patients: the Al-Ándalus project

OBJECTIVE

To compare the levels of physical activity (PA) assessed with questionnaires (Leisure Time Physical Activity Instrument [LTPAI], Physical Activity at Home and Work Instrument [PAHWI]) and accelerometry in patients with fibromyalgia; and to analyze the test-retest reliability of these questionnaires.

DESIGN

Cross-sectional study.

SETTING

Local fibromyalgia association.

PARTICIPANTS

Participants (N=99; 5 men) with fibromyalgia with a mean age of 50.2±9.5 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants carried an accelerometer for 1 week and completed the LTPAI and PAHWI twice (separated by a 1-wk interval). The LTPAI and PAHWI were summed to obtain overall values of PA.

RESULTS

Time spent in total, moderate, and moderate-vigorous PA was higher (P<.01) when assessed by the LTPAI and PAHWI compared with accelerometry. The Bland-Altman method showed an absence of agreement between the LTPAI and PAHWI and the accelerometer for moderate, moderate-vigorous, and total PA. The test-retest reliability for the workplace subscale and total score of the PAHWI showed high and moderate intraclass correlation coefficients (ICCs), respectively, but also manifested high SE of measurements (up to 179min/d). The LTPAI showed low to moderate ICCs and high SE of measurements (up to 79min/d). For the LTPAI and PAHWI, the ICCs for total activity across the population were low to moderate, and the Bland-Altman method confirmed this lack of agreement.

CONCLUSIONS

The LTPAI and PAHWI and the accelerometer differ greatly when assessing PA. Furthermore, the LTPAI and PAHWI did not show good levels of test-retest reliability. Therefore, the self-administered LTPAI and PAHWI show questionable usefulness to assess PA in populations with fibromyalgia.

Predicting fibromyalgia, a narrative review: are we better than fools and children?

Fibromyalgia syndrome (FMS) is a common and intriguing condition, manifest by chronic pain and fatigue. Although the pathogenesis of FMS is not yet completely understood, predicting the future development of FMS and chronic pain is a major challenge with great potential advantages, both from an individual as well as an epidemiological standpoint. Current knowledge indicates a genetic underpinning for FMS, and as increasing data are accumulated regarding the genetics involved, the prospect of utilizing these data for prediction becomes ever more attractive. The co-existence of FMS with multiple other functional disorders indicates that the clinical identification of such symptom constellations in a patient can alert the physician to the future development of FMS. Hypermobility syndrome is another clinical (as well as genetic) phenotype that has emerged as a risk factor for the development of FMS. Stressful events, including early life trauma, are also harbingers of the future development of FMS. Functional neuroimaging may help to elucidate the neural processes involved in central sensitization, and may ultimately also evolve into markers of predictive value. Last but not least, obesity and disturbed sleep are clinical (inter-related) features relevant for this spectrum. Future efforts will aim at integrating genetic, clinical and physiological data in the prediction of FMS and chronic pain.