Intensity level for exercise training in fibromyalgia by using mathematical models

Effects of photobiomodulation and an aerobic exercise on the level of pain and quality of life in women with fibromyalgia

To evaluate the effectiveness of photobiomodulation (PBM) in conjunction with an aerobic exercise program (AEP) on the level of pain and quality of life of women with fibromyalgia (FM).

METHODS

A double-blinded randomized controlled trial in which 51 participants with FM were allocated into 4 groups: control group (CG) (n = 12); active PBM group (APG) (n = 12); AEP and placebo PBM group (EPPG) (n = 13); AEP and active PBM group (EAPG) (n = 14). AEP was performed on an ergometric bicycle; and a PBM (with an increase dosage regime) [20 J, 32 J and 40 J] was applied using a cluster device. Both interventions were performed twice a week for 12 weeks. A mixed generalized model analysis was performed, evaluating the time (initial and final) and group (EAPG, EPPG, APG and CG) interaction. All analyses were based on intent-to-treat for a significance level of p ≤ 0.05.

RESULTS

The intra-group analysis demonstrated that all treated groups presented a significant improvement in the level of pain and quality of life comparing the initial and final evaluation (p < 0.05). Values for SF-36 and 6-minute walk test increased significant in intragroup analysis for EPPG comparing the initial and final evaluation. No intergroup differences were observed.

CONCLUSIONS

Both exercised and PBM irradiated volunteers present improvements in the variables analyzed. However, further studies should be performed, with other PBM parameters to determine the best regime of irradiation to optimize the positive effects of physical exercises in FM patients.

The Efficiency of Kinesiotherapy versus Physical Modalities on Pain and Other Common Complaints in Fibromyalgia

Due to its variety of signs and symptoms, there have been numerous attempts to treat fibromyalgia (FM), but a cure has yet to be established. The aim of this study was to evaluate the effects of a complex kinetic therapy program and a combined physical modality program on pain and other common symptoms of FM. Patients and methods: A total of 78 female patients were included in this study; 39 subjects underwent a kinesiotherapy (KT) intervention (combining aerobic and Pilates exercises), and 39 participated in a physical modality (PM) program (including electrotherapy (TENS and low-laser therapy) and thermotherapy). Results: Regarding the parameter of pain assessment, kinesiotherapy demonstrated its superiority both during the treatment period and in the evaluation 3 months after therapy cessation. Both in terms of patient-reported pain (inter-group comparisons: p = 0.000 at T3) and the examination of tender points (inter-group comparisons: p = 0.000 at T3), as well as the algometric assessment, pain was alleviated by the two forms of applied kinetic therapy. The observed functional impairment was statistically significantly influenced (p = 0.001) at the end of the kinetic program application, while for the perceived functional impairment, neither therapy proved superiority over the other at any point of evaluation (inter-group comparisons: p = 0.715 at T3). Regarding the influence of the emotional consequences implied by fibromyalgia, neither the forms of kinesiotherapy nor the chosen physical modalities proved superiority at any point of evaluation (HAQ anxiety inter-group comparisons: p = 0.000 at T3). In conclusion, even though kinesiotherapy had superior influences on fibromyalgia pain in the studied group, the current research lends credence to the significance of non-pharmacological therapy in managing fibromyalgia. Participants demonstrated positive advancements in subjective and objective pain assessments, as well as improvements in functional and emotional well-being.

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.

Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren's syndrome: a randomized-controlled trial

OBJECTIVE

The aim of this study was to evaluate the safety and effectiveness of a supervised walking program in women with primary Sjögren's syndrome (pSS).

METHODS

Forty-five sedentary women fulfilling the American European Consensus Criteria for pSS were randomized to a training group (TG, n = 23) or control group (CG, n = 22). Patients in the TG were submitted to supervise walking three times a week for 16 weeks. The patients of the CG were instructed to not perform any kind of regular physical exercise. Physical fitness [maximum oxygen uptake (VO2max) and distance], EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), hematological tests, and Medical Outcomes Study 36 (SF-36) were assessed at baseline and week 16. In addition, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-fatigue), and Beck Depression Inventory (BDI) were measured prior to intervention, after 8 and 16 weeks. Patient global assessment of response to therapy was completed at the final assessment. An intent-to-treat analysis was performed.

RESULTS

After 16 weeks, the mean change of VO2max (ml/kg/min), distance, and FACIT-fatigue were higher in the TG than in the CG (p = 0.016, p = 0.043 and p = 0.030, respectively). Improved cardiorespiratory fitness was associated with improvements in fatigue scores and physical components of quality of life (SF-36). Furthermore, improved fatigue scores were associated with reduced depression and improvements in the physical and mental components of SF-36. Overall, 95.4% of patients in the TG rated themselves as clinically improved versus 62% of the patients in the CG (p = 0.049). There was no flare in disease activity and no serious adverse events with exercise.

CONCLUSIONS

This supervised walking program was demonstrated to be feasible and safe with improvements in cardiorespiratory fitness, exercise tolerance, fatigue, and patient perception of improvement in pSS patients.

TRIAL REGISTRATION

Clinical Trials.gov ID, number NCT02370225.

Effectiveness and cost-effectiveness of the modified Pilates method versus aerobic exercise in the treatment of patients with fibromyalgia: protocol for a randomized controlled trial

Background

Fibromyalgia is characterized by chronic generalized pain, fatigue, sleep disorders and other symptoms. Physical exercise is recommended as the first choice of non-pharmacological therapy. Thus, the aim of this study is to evaluate the effectiveness and cost-effectiveness of modified Pilates exercises compared to aerobic exercises in the treatment of patients with fibromyalgia.

Methods

In this randomized controlled trial with blinded assessor, 98 patients who meet the fibromyalgia classification criteria of the American College of Rheumatology 2010, aged between 20 and 75 years, and with pain intensity greater than or equal to 3 points in the Pain Numerical Rating Scale, will be randomly divided into Aerobic Group (aerobic exercises on treadmills or stationary bikes) and Pilates Group (modified Pilates exercises), and treated twice a week for eight weeks on the Center for Excellence in Clinical Research in Physical Therapy at Universidade Cidade de São Paulo, Brazil. The following outcomes will be evaluated by a blinded assessor at baseline, eight weeks, six months, and 12 months after randomization: impact of fibromyalgia assessed by the Fibromyalgia Impact Questionnaire, pain intensity by the Pain Numerical Rating Scale, kinesiophobia by the Tampa Scale of Kinesiophobia, specific disability by the Patient-Specific Functional Scale, functional capacity by the 6-min Walk Test, quality of sleep by the Pittsburgh Sleep Quality Index, and health-related quality of life by EQ-5D-3L and SF-6D questionnaires.

Discussion

It is expected that the Pilates exercises will be more effective than aerobic exercises in improving clinical outcomes and that this improvement will be maintained over the medium to long term. This study aims to clarify whether the Pilates method can be incorporated into the clinical practice of physical therapists treating patients with fibromyalgia. The study will also provide information on which exercise will be most cost-effective, information that can be used by insurers and public health systems.

Trial registration

This study was prospectively registered at the Clinical Trials Registry (NCT03050606) in February 2017.

Combination of Exercise and Acupuncture Versus Acupuncture Alone for Treatment of Myofascial Pain Syndrome: A Randomized Clinical Trial

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder. This study was designed to compare the effects of aerobic exercise plus acupuncture with acupuncture alone in treatment of patients with MPS. Sixty-four patients (55 female and 9 male) with MPS in their neck and shoulders participated in the study with mean age of 33.1 ± 6.4 years. Participants were randomly allocated to aerobic exercise plus acupuncture (n = 32) or acupuncture alone (n = 32) groups. Outcome measurements included visual analog scale, pressure pain threshold, neck disability index, and quality of life that was measured with QoL-SF36 scale. Each group received 10 sessions of acupuncture in combination with aerobic exercise or acupuncture alone. The outcome measures were evaluated at baseline, at the end of the last treatment session, and at 1-month follow-up visit. While participants were waiting for their 1-month follow-up visit, the patients who received combination therapy were asked to continue their aerobic exercise by jogging 40 minutes a day. Although mean visual analog scale, pressure pain threshold, neck disability index, and QoL-SF36 were significantly improved in both groups (p < 0.001), there was no statistically significant difference among the measures between the two groups throughout the evaluated sessions. The interaction effect of time and groups did not show any significant difference among the outcome measures (p > 0.29).

Efeitos da pompage associada ao exercício aeróbico sobre dor, fadiga e qualidade do sono em mulheres com fibromialgia: um estudo piloto

RESUMO O objetivo da pesquisa foi avaliar os efeitos da pompage como terapia complementar a exercícios aeróbicos e de alongamento sobre dor, fadiga e qualidade do sono em mulheres com fibromialgia. Para isso, 23 mulheres com esse diagnóstico foram alocadas aleatoriamente nos grupos: Experimental (GE, n=13) e Controle (GC, n=10), e em seguida foram avaliadas através do Questionário McGill de Dor, Questionário de Fadiga de Chalder e Inventário do Sono. Durante 12 semanas, duas vezes por semana, o GE realizou pompage, exercícios aeróbicos e alongamentos, enquanto o GC fez apenas exercícios aeróbicos e alongamentos. A avaliação foi repetida após 6 e 12 semanas. Ocorreram perdas amostrais, resultando em 15 indivíduos (GE, n=7/GC, n=8). Na análise estatística, utilizou-se ANOVA para medidas repetidas, seguido do teste t para amostras independentes em que houve diferença significativa (p ≤ 0,05). Houve redução significativa do escore da dimensão mista do Questionário McGill de Dor após 12 semanas no GE comparado ao GC. Nos outros aspectos avaliados de dor, fadiga e qualidade do sono, não foram observadas alterações significativas. Assim, sugere-se que a pompage como terapia complementar a exercícios aeróbicos e de alongamento não apresentou efeitos benéficos importantes para mulheres com fibromialgia, uma vez que houve melhora em apenas uma das dimensões de dor avaliadas. Estudos com amostras maiores são necessários para uma análise mais consistente dos desfechos investigados.

Physiological parameters as a tool in the diagnosis of fibromyalgia syndrome in females: A preliminary study

AIMS

Although fibromyalgia (FM) syndrome is associated with many symptoms, there is as yet no specific finding or laboratory test diagnostic of this syndrome. The physical examination and laboratory tests may be helpful in figuring out this syndrome.

MATERIALS AND METHODS

The heart rate, respiration rate, body temperature (TEMP), height, body weight, hemoglobin level, erythrocyte sedimentation rate, white blood cell count, platelet count (PLT), rheumatoid factor and C-reactive protein levels and electrocardiograms (ECG) of FM patients were compared with those of control individuals. In addition, the predictive value of these tests was evaluated via receiver operating characteristic (ROC) analysis.

KEY FINDINGS

The results showed that the TEMP and the PLT were higher in the FM group compared with the control group. Also, ST heights in ECGs which corresponds to a period of ventricle systolic depolarization, showed evidence of a difference between the FM and the control groups. There was no difference observed in terms of the other parameters. According to the ROC analysis, PLT, TEMP and ST height have predictive capacities in FM.

SIGNIFICANCE

Changes in hormonal factors, peripheral blood circulation, autonomous system activity disorders, inflammatory incidents, etc., may explain the increased TEMP in the FM patients. The high PLT level may signify a thromboproliferation or a possible compensation caused by a PLT functional disorder. ST depression in FM patients may interrelate with coronary pathology. Elucidating the pathophysiology underlying the increases in TEMP and PLT and the decreases in ST height may help to explain the etiology of FM.

Evaluation of the effectiveness of an aerobic exercise program and the personality characteristics of patients with fibromyalgia syndrome: a pilot study

[Purpose] The aim of this study was to assess the effectiveness of a 6-week aerobic exercise program on pain, physical function, and psychological status, and to evaluate the personality characteristics of fibromyalgia syndrome (FMS) patients. [Subjects and Methods] Fourteen women with FMS were enrolled. They were trained for a 6-week home-based aerobic exercise program. The Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the visual analog scale of pain and sleep quality were measured at baseline and at the end of week 6. The personality profiles were evaluated using the Minnesota Multiphasic Personality Inventory (MMPI). [Results] After the exercise program, significant improvements were determined in pain, sleep quality, physical function, depression and FMS symptoms compared to baseline. In addition, the hysteria item (71.21±8.84) of the MMPI was significantly higher in FMS. [Conclusion] Our findings indicate that home-based aerobic exercise may be a useful treatment in the management of FMS. Personality characteristics should be considered during the planning process of the treatment of FMS. Personality is a filter between life events and psychological responses. It is defined to be the integration of effective and behavioral patterns. Long-term studies involving larger clinical samples are needed to define the role of personality characteristics in FMS.

Exercise therapy for fibromyalgia

Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction, and other somatic symptoms, negatively impacts physical and emotional function and reduces quality of life. Exercise is commonly recommended in the management of people with fibromyalgia, and interest in examining exercise benefits for those with the syndrome has grown substantially over the past 25 years. Research supports aerobic and strength training to improve physical fitness and function, reduce fibromyalgia symptoms, and improve quality of life. However, other forms of exercise (e.g., tai chi, yoga, Nordic walking, vibration techniques) and lifestyle physical activity also have been investigated to determine their effects. This paper highlights findings from recent randomized controlled trials and reviews of exercise for people with fibromyalgia, and includes information regarding factors that influence response and adherence to exercise to assist clinicians with exercise and physical activity prescription decision-making to optimize health and well-being.