Peak expiratory flow rate and thoracic mobility in people with fibromyalgia. A cross sectional study

Motor Dysfunctions in Fibromyalgia Patients: The Importance of Breathing

The classification of fibromyalgia (FM) is not always immediate and simple, with the time from the first diagnosis, compared to the onset of symptoms, of a few years. Currently, we do not have instrumental or biochemical tests considered as gold standards; the clinician will make a diagnosis of FM based on the patient's medical history and subjective assessment. The symptoms can involve physical, cognitive and psychological disorders, with the presence of pain of different origins and classifications: nociplastic, nociceptive and neuropathic pain. Among the symptoms highlighted, postural disorders and neuromotor uncoordination emerge, whose functional dysfunctions can increase the mortality and morbidity rate. An alteration of the diaphragm muscle could generate such functional motor problems. Considering that the current literature underestimates the importance of breathing in FM, the article aims to highlight the relationship between motor and diaphragmatic difficulties in the patient, soliciting new points of view for the clinical and therapeutic framework.

Hypocapnia in women with fibromyalgia

OBJECTIVES

The purpose of this study was to investigate whether people with fibromyalgia (FM) have dysfunctional breathing by examining acid-base balance and comparing it with healthy controls.

METHODS

Thirty-six women diagnosed with FM and 36 healthy controls matched for age and gender participated in this cross-sectional study. To evaluate acid-base balance, arterial blood was sampled from the radial artery. Carbon dioxide, oxygen, bicarbonate, base excess, pH and lactate were analysed for between-group differences. Blood gas analyses were performed stepwise on each individual to detect acid-base disturbance, which was categorized as primary respiratory and possible compensation indicating chronicity. A three-step approach was employed to evaluate pH, carbon dioxide and bicarbonate in this order.

RESULTS

Women with FM had significantly lower carbon dioxide pressure (p = 0.013) and higher lactate (p = 0.038) compared to healthy controls at the group level. There were no significant differences in oxygen pressure, bicarbonate, pH and base excess. Employing a three-step acid-base analysis, 11 individuals in the FM group had a possible renally compensated mild chronic hyperventilation, compared to only 4 among the healthy controls (p = 0.042).

CONCLUSIONS

In this study, we could identify a subgroup of individuals with FM who may be characterized as mild chronic hyperventilators. The results might point to a plausible dysfunctional breathing in some women with FM.

Respiratory Function Analysis in Patients with Chronic Pain: An Umbrella Review and Meta-Analysis of Pooled Findings

BACKGROUND

The main aim of this umbrella review was to assess the respiratory function in patients with chronic pain (CP), including patients with chronic neck pain (CNP), chronic low back pain (CLBP), and fibromyalgia syndrome (FMS).

METHODS

We searched in PubMed, PEDro, EMBASE, CINAHL, and Google Scholar (4 February 2023). The outcome measures were respiratory muscle strength (MIP/MEP) and pulmonary function (VC, MVV, FVC, FEV₁, FEV₁/FVC ratio, FEV_25-75, and PEF). This review was previously registered in the international prospective register of systematic reviews, PROSPERO (CRD42023396722). The methodological quality was analyzed using AMSTAR and ROBIS scales, and the strength of the evidence was established according to the guidelines advisory committee grading criteria. To compare the outcomes reported by the studies, we calculated the standardized mean differences and the corresponding 95% confidence interval for the continuous variables.

RESULTS

Four systematic reviews with and without meta-analysis were included, from which a total of 15 primary studies were extracted. Five meta-analyses were carried out, using analyses by subgroup according to the type of CP. The meta-analyzing variables were MIP, MEP, MVV, FEV₁, and FVC.

CONCLUSIONS

Overall, patients with CP have decreased respiratory muscle strength with a moderate quality of evidence. Regarding the pulmonary function, patients with CNP showed a diminished VC, PEF, MVV, FEV₁, and FVC, while FEV_25-75 and the FEV₁/FVC ratio were conserved with a limited to moderate quality of evidence. Finally, patients with FMS and CLBP only showed a decrease in MVV with a limited quality of evidence.

Effects of an Exercise for Well-Being and Physical Training Programme on Muscle Strength, Range of Movement, Respiratory Capacity and Quality of Life in Women with Fibromyalgia: A Randomized Controlled Trial

The objective of this study was to assess the efficacy of an active exercise physiotherapy programme versus an exercise for well-being programme improving muscle strength, range of movement, respiratory capacity and quality of life of women with fibromyalgia. A randomized, assessor-blind, controlled trial was conducted. A total of 141 women diagnosed with fibromyalgia were randomized to a physiotherapy exercise group (n = 47), an exercise for well-being group (n = 47) and a control group (n = 47). The study lasted 4 weeks and the experimental groups received 45 min sessions performed twice a week on alternate days. The primary outcome measures were range of movement and muscle strength. The secondary outcome measures were respiratory capacity and quality of life. The results showed statistically significant improvements in the exercise for well-being and physiotherapy groups vs. the control group at week 5 in relation to joint range of movement (p = 0.004), muscle strength (p = 0.003) and quality of life (p = 0.002). The changes found in all the spirometry parameters seem to be associated to some of the changes in joint range of movement and muscle strength as well as quality of life. Physiotherapy and exercise for well-being improved upper limb and lower limb range of movement and the muscle strength of women with fibromyalgia.

Effects of Hypopressive Exercise on Posterior Back Chain Kinematics and Pulmonary Function in Professional Female Basketball Players

CONTEXT

Hypopressive exercise (HE) has been used as an alternative lumbo-pelvic injury prevention program and claimed to be a means of respiratory and flexibility improvement. However, the possible effects of HE on athletic populations and physical performance remain unclear.

OBJECTIVE

Examine the effects of a HE program on posterior back chain kinematics, thoracic mobility, pulmonary function, and lower lumbar pain in female basketball players over an 8-week training period.

DESIGN

Prospective (1) baseline, (2) midpoint (4 wk), and (3) after 8 weeks.

SETTING

Sports field.

PARTICIPANTS

A total of 17 professional female basketball players (mean age 20.7 y, SD: 3.50; body mass index, 21.71, SD: 1.69).

INTERVENTION

Participants performed 8 HE weekly sessions of 30 minutes.

MAIN OUTCOME MEASURES

Back chain kinematics was assessed with the sit and reach and finger to floor test, and back pain was assessed through numerical rating scale. Respiratory parameters were assessed by spirometry and through thoracic mobility.

RESULTS

The analysis of variance revealed significant differences between the 3 measurement periods for thoracic mobility (P > .01); forced expiratory volume in the first second (P < .05) while no statistical differences were found for the rest of spirometry outcomes. Significant differences were also revealed between baseline and after the intervention for the sit and reach test (P > .01), peak expiratory flow (P = .01), and forced expiratory volume in the first 25 seconds (P = .04). Also, significant differences between weeks were found in levels of lumbar pain (P = .003) and the finger to floor test (P = .002).

CONCLUSIONS

These preliminary findings suggest that a HE program can improve posterior back chain and chest wall kinematics as well as lower lumbar pain levels. However, no gains seem to be observed for the majority of pulmonary variables except for peak expiratory flow and forced expiratory volume in the first seconds.