Acute heavy-resistance exercise–induced pain and neuromuscular fatigue in elderly women with fibromyalgia and in healthy controls: Effects of strength training

Onset of chronic pain triggered by a lifestyle-change-based weight loss and exercise regimen

Exercise and weight loss are commonly recommended to patients with chronic pain; these interventions can relieve extra stress on the joints, reduce the perception of pain and combat comorbidities such as obesity, anxiety and depression. However, exercise can also exacerbate existing pain, presenting challenges for adherence to exercise and weight loss regimens. Here, we summarise the unique case of a patient who presented with chronic pain that developed during a natural weight loss regimen. The patient sought assessment due to diffuse pain that commenced after significant weight loss and was exacerbated with continued adherence to lifestyle modifications. He received a diagnosis of fibromyalgia and is currently being treated with nerve blocks and local anaesthetic injections of trigger points. This case of onset of fibromyalgia and chronic pain following lifestyle changes and weight loss underscores the need for further research aiming to understand the complex relationship between exercise, weight loss and chronic pain.

Effects of resistance training on pain, functionality and quality of life in women with fibromyalgia: A systematic review

INTRODUCTION

Fibromyalgia is a chronic syndrome characterized by constant and generalized pain associated with sleep disturbance, depression, muscle stiffness, fatigue and cognitive disorders. Among non-pharmacological treatments, physical exercise stands out as a low-cost approach.

AIM

To summarize and analyze evidence on the effects of resistance training on pain, functionality and quality of life in women with fibromyalgia.

METHODS

Following the PRISMA method, this systematic review included clinical trials assessing the effects of resistance training on pain, quality of life and functionality in female patients with fibromyalgia, regardless age. The researches were conducted in April 2021 in PubMed, Cochrane, Web of Science and Scopus databases, using the search strategy: ("fibromyalgia") AND ("strength training" OR "resistance training") AND ("quality of life" OR "pain" OR "functionality"). This study was registered in PROSPERO (CRD number: 42,021,246,245), and the risk of bias was assessed using the Version 2 of the Cochrane Risk-of-Bias tool (RoB 2).

RESULTS

The search resulted in 125 studies (760 women), of which 16 were eligible for this review. Risk of bias assessment resulted in high (n = 5), moderate (n = 6) and low (n = 5) risks. Resistance training has proven to be an important non-pharmacological treatment tool for fibromyalgia, reducing pain, and improving patients' functionality and quality of life.

CONCLUSION

The available evidence suggests that resistance training performed twice weekly, with progressive loads ranging from 40 to 80% of one-repetition maximum and a total duration of 4-24 weeks, appears to be an effective and safe therapeutic approach.

The Behavior of Muscle Oxygen Saturation, Oxy and Deoxy Hemoglobin during a Fatigue Test in Fibromyalgia

Previous studies have reported that people with fibromyalgia (FM) could suffer from mitochondrial dysfunction. However, the consumption of muscle oxygen during physical exercise has been poorly studied. Therefore, this study aimed to explore the response of muscle oxygen during a fatigue protocol in people with FM and healthy controls (HC). In addition, the peak torque and the total work were assessed. A total of 31 participants (eighteen were people with fibromyalgia and thirteen were healthy controls) were enrolled in this cross-sectional study. All the participants underwent a fatigue protocol consisting of 20 repetitions at 180°·s−1 of quadriceps flexions and extensions using a Biodex System 3. The muscle oxygen saturation (SmO2), total hemoglobin (THb), deoxygenated hemoglobin (HHb) and oxygenated hemoglobin (O2Hb) values were measured using a portable near-infrared spectroscopy (NIRS) device. Significant differences between people with FM and healthy controls were found at baseline: SmO2 (FM: 56.03 ± 21.36; HC: 77.41 ± 10.82; p = 0.036), O2Hb (FM: 6.69 ± 2.59; HC: 9.37 ± 1.31; p = 0.030) and HHb (FM: 5.20 ± 2.51; HC: 2.73 ± 1.32; p = 0.039); during the fatigue protocol: SmO2 (FM: 48.54 ± 19.96; HC: 58.87 ± 19.72; p = 0.038), O2Hb (FM: 5.70 ± 2.34; HC: 7.06 ± 2.09; p = 0.027) and HHb (FM: 5.69 ± 2.65; HC: 4.81 ± 2.39; p = 0.048); and in the recovery at three min and six min for SmO2, O2Hb and HHb (p < 0.005). Furthermore, healthy control values of SmO2, O2Hb and HHb have been significantly altered by the fatigue protocol (p < 0.005). In contrast, people with FM did not show any significant alteration in these values. Moreover, significant differences were found in the peak torque at extension (FM: 62.48 ± 24.45; HC: 88.31 ± 23.51; p = 0.033) and flexion (FM: 24.16 ± 11.58; HC: 42.05 ± 9.85; p = 0.010), and the total work performed at leg extension (FM: 1039.78 ± 434.51; HC: 1535.61 ± 474.22; p = 0.007) and flexion (FM: 423.79 ± 239.89; HC: 797.16 ± 194.37; p = 0.005).

Gradual Strength Training Improves Sleep Quality, Physical Function and Pain in Women with Fibromyalgia

BACKGROUND

Fibromyalgia (FM) is characterized by chronic and generalized musculoskeletal pain. There is currently no cure for FM, but alternative treatments are available. Among them, gradual strength training programs (ST) which on daily activities are a valid option to improve some of the pronounced symptoms of FM that affect quality of life, such as fatigue, pain, sleep quality, and physical function. However, there is a need for more information on optimal training programs to improve anxiety and fatigue symptoms.

AIM

To analyze the effects of a 24-week gradual and progressive ST on sleep quality, fatigue, pain domains, physical function, and anxiety-state.

METHODS

41 women with FM participated in the 24 weeks of intervention based on gradual and progressive ST. Two, 60 min, training sessions per week were con-ducted. Participants were evaluated before the ST program (week 0), in week 12 and at the end of the ST program (week 24). The Revised Fibromyalgia Impact Questionnaire was used to assess sleep quality and fatigue scales. Anxiety-state was evaluated with the State Anxiety Inventory, and pain domains by means of the Brief Pain Inventory. Senior Fitness Test was used for physical function measurements. One-way analysis of variance (ANOVA) was applied to assess the mean differences between phases, and Spearman's correlations were used to assess the associations between physical and psychological symptoms, and physical function.

RESULTS

The results demonstrated that 24 weeks of ST improves physical function, sleep quality and pain domains (p ≤ 0.05). Higher anxiety and pain interference scores were related to worsening physical function.

CONCLUSIONS

Gradual ST significantly improves sleep quality, pain, and physical function, but not anxiety and fatigue.

Effects of resistance training on the physical symptoms and functional capacity of patients with fibromyalgia: a systematic review and meta-analysis of randomized clinical trials

BACKGROUND

Resistance training (RT) has become an important topic for the treatment of fibromyalgia (FM); however, there are still controversies regarding its ability to significantly improve physical symptoms and a lack of adequate recommendations for evidence-based practice.

AIM

The aim of this study is to analyze the effects of RT on the physical symptoms of patients with FM through a systematic review with meta-analysis.

METHODS

We conducted a systematic review of randomized controlled trials in June 2022, according to PRISMA recommendations. The searches were carried out on the databases PubMed, Embase, Science Direct, Web of Science, PEDro, CINAHL, SciELO, and Google Scholar for gray literature, and the protocol was recorded in PROSPERO. Studies that evaluated patients with FM undergoing an RT program lasting more than 2 weeks and that analyzed physical health were selected. To carry out the meta-analysis, the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions were followed.

RESULTS

In total, 13 studies were included for qualitative analysis and nine for meta-analysis. Regarding meta-analysis, a favorable improvement was found for pain ([MD =  - 10.22 (95% CI: - 18.86 to - 1.58; I²: 64%; P for heterogeneity: 0.003)]; very low quality of evidence {QoE}), fatigue ([SMD =  - 0.39 (95% CI: - 0.61 to - 0.17; I²: 0%; P = 0.91)]; moderate QoE), and muscle strength ([SMD = 0.94 (95% CI: 0.02 to 1.85; I²: 93%; for heterogeneity: < 0.0001)]; very low QoE) and improvement in functional capacity ([MD = 18.75 (95% CI: 4.27 to 33.22; I²: 39%; P = 0.19)]; low QoE), in the general comparison.

CONCLUSION

RT was effective in reducing pain and fatigue and increasing strength and functional capacity; however, due to the quality of the evidence, more studies are needed.

Concurrent Training Increases Serum Brain-Derived Neurotrophic Factor in Older Adults Regardless of the Exercise Frequency

Background

Human brain function declines with aging. In this sense, exercise-based interventions has a promising effect on brain plasticity for older adults. Serum brain-derived neurotrophic factor (BDNF) is a positive biomarker for brain neuroplasticity in healthy older adults also modified by exercise training. Selected features of the exercise prescription for improving brain health are missing; therefore, the aim of this study was to determine the effects of concurrent exercise training frequency on serum BDNF levels in healthy older adults.

Methods

Nineteen volunteers (age: 65 ± 4 year; body mass index: 28.0 ± 4.5 kg/m²) completed either a three times/week (3-t/w) (n = 8) or five times/week (5-t/w) (n = 11) concurrent exercise program. The exercise program lasted 11 weeks and all exercise sessions were performed for 50 min at moderate intensity. Serum BDNF, body composition, cardiovascular, and physical fitness variables were assessed before and after the exercise training program.

Results

Regardless of the group, the serum BDNF increased following the intervention (p < 0.001), and there were no significant group (p = 0.827) or interaction (p = 0.063) effects. The maximal oxygen consumption (VO2max) increased regardless of the group (p = 0.007), with a non-significant group (p = 0.722) or interaction (p = 0.223) effects. Upper- and lower-body strength increased in both groups (p = 0.003); however, there was no effect of the training frequency (p = 0.53). For the skeletal muscle mass, there was a trend in the interaction effect (p = 0.053). Finally, the body fat percentage was unchanged.

Conclusion

Eleven weeks of combined exercise training increased serum BDNF levels in healthy older adults, a response independent of the training frequency. The overall fitness level improved similarly in both exercise groups. These data reveal that a minimal dosage of concurrent exercise enhance functional capacity and a brain health biomarker in older adults.

Women with Fibromyalgia Prefer Resistance Exercise with Heavy Loads-A Randomized Crossover Pilot Study

Fibromyalgia (FM) is a chronic pain condition associated with impaired muscle strength and exercise-induced pain. Physical exercise has been highlighted, by international clinical guidelines and stakeholders, as an essential component of rehabilitation in FM. Exposure to pain during exercise is generally correlated with elevated lactate levels and, additionally, is one known reason for persons with FM to avoid physical exercise and activity. A crossover design was used to test and evaluate an approach consisting of resistance exercise with heavy loads and a low number of repetitions among ten women with FM. The participants were consecutively recruited to test and perform exercise with two different resistance levels (A = light/moderate load, and B = heavy load) in a randomized crossover trial using an AB/BA setting. Results showed that the heavy load exercise session was experienced as more positive than the light/moderate load exercise session and that lower lactate levels followed exercise with heavier weight loads. This is promising and indicates that the approach of heavy weight loads and accustomed repetitions is accepted in FM and has the potential to attenuate hesitation to exercise due to exercise-induced pain. However, these effects need to be further investigated in more extensive studies.

Free gait in a shallow pool accelerates recovery after exercise in model mice with fibromyalgia

This study aimed to determine the effect of pool gait exercise using fibromyalgia-induced model mice. The sensory threshold, locomotive behavior, electrocardiogram, and onset time after the gait test in shallow water using male C57BL/6J mice (weight, 30–35 g; n=21) were investigated. To induce fibromyalgia in model mice, reserpine was injected intraperitoneally into wild-type mice once a day for 3 days. Subsequently, the fibromyalgia-induced model mice were randomly classified into two groups as follows: the control group (n=11) and the pool gait group (n=10). The mice in the pool gait group walked in the same cage containing shallow warm water 5 times per week. Both groups underwent sensory thresholds and video recordings to determine locomotive behaviors weekly. Further, both heart rate and video recordings for observation of a recovery after the gait test in shallow water were undertaken (control group; n=5, pool gait group; n=5). The pool gait did not affect sensory thresholds and locomotive behavior; however, in the pool gait group, both the recovery after the test, such as onset time and gait distance, were considerably better than those of the control group. Furthermore, changes in heart rate and heart rate irregularity after the test were more apparent in the control group than in the pool gait group. The free gait in a shallow pool accelerated recovery after exercise, unlike the sensory threshold.

Acute Effects of Different Rest Intervals Between Sets of Resistance Exercise on Neuromuscular Fatigue in Trained Older Women

Jambassi Filho, JC, Gurjão, ALD, Prado, AKG, Gallo, LH, and Gobbi, S. Acute effects of different rest intervals between sets of resistance exercise on neuromuscular fatigue in trained older women. J Strength Cond Res 34(8): 2235-2240, 2020-The aim of this study was to investigate the acute effect of different rest intervals (RIs) between sets on total volume, time under tension, maximal voluntary contraction (MVC), and integrated electromyography (iEMG) activity of the vastus lateralis (VL) and vastus medialis (VM) muscles. Twenty-one resistance-trained older women (66.4 ± 4.4 years; 69.1 ± 11.4 kg; 157.5 ± 5.0 cm) completed 3 different test sessions, performed 48-72 hours apart, in a randomized and counterbalanced within-subjects design. In 2 test sessions, the participants performed 3 sets to voluntary exhaustion with loads that corresponded to 15 maximum repetitions, with either 1-minute RI (RI-1) or 3-minute RI (RI-3). In another test session, the participants remained at rest for 15 minutes. The total volume of exercise and time under tension for the RI-3 session was statistically higher (p ≤ 0.05) than the RI-1 session. Postexercise MVC for the RI-3 session showed significantly greater reductions (-7.8%; p ≤ 0.05) compared with the RI-1 and control sessions. No significant changes in postexercise iEMG activity of the VL and VM were shown for any of the sessions (all p > 0.05). The findings of this study suggest that different RIs between sets lead to different acute neuromuscular responses. The longer RI seemed to induce higher neuromuscular fatigue, likely due to higher total volume and time under tension. Thus, longer RI may be a strategy that possibly would lead to greater long-term gains in muscle strength and hypertrophy of the lower limbs in trained older women.

A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations

BACKGROUND

Fibromyalgia (FM) is characterized by chronic and generalized musculoskeletal pain. There is currently no cure for FM, but palliative treatments are available. One type of treatment is strength training (ST). However, there is a need for more information on optimal training protocols, intensity, and volume needed to improve symptoms. The aim of this study was to analyze the effects of ST in the treatment of FM through a systematic review of experimental research.

METHODS

Medical Subject Headings search terms and electronic databases including Scientific Electronic Library Online, PubMed, Science Direct, Web of Science, and Physiotherapy Evidence Database were used to identify studies.

RESULTS

The inclusion criteria were met by 22 eligible studies. Most of the studies were conducted in the United States (36%), Finland (23%), Brazil (18%), and Sweden (18%). The studies showed that ST reduces the number of tender points, fatigue, depression, and anxiety, and improves sleep quality and quality of life in patients with FM. The intervention period ranged from 3 to 21 weeks, with sessions performed 2 times a week in 81.81% of the studies, at initial intensities of 40% of 1-repetition maximum. The repetitions ranged from 4 to 20, with no specific protocol defined for ST in FM.

CONCLUSION

The main results included reduction in pain, fatigue, number of tender points, depression, and anxiety, with increased functional capacity and quality of life. Current evidence demonstrates that ST is beneficial and can be used to treat FM.

TRIAL REGISTRATION

CRD42016048480.

Characterization of postural control impairment in women with fibromyalgia

The main goal of this cross-sectional study was to detect whether women with fibromyalgia syndrome (FMS) have altered postural control and to study the sensory contribution to postural control. We also explored the possibility that self-induced anxiety and lower limb strength may be related to postural control. For this purpose, 129 women within an age range of 40 to 70 years were enrolled. Eighty of the enrolled women had FMS. Postural control variables, such as Ellipse, Root mean square (RMS) and Sample entropy (SampEn), in both directions (i.e. mediolateral and anteroposterior), were calculated under five different conditions. A force plate was used to register the center of pressure shifts. Furthermore, isometric lower limb strength was recorded with a portable dynamometer and normalized by lean body mass. The results showed that women with FMS have impaired postural control compared with healthy people, as they presented a significant increase in Ellipse and RMS values (p<0.05) and a significant decrease in SampEn in both directions (p<0.05). Postural control also worsens with the gradual alteration of sensory inputs in this population (p<0.05). Performing a stressor dual task only impacts Ellipse in women with FMS (p>0.05). There were no significant correlations between postural control and lower limb strength (p>0.05). Therefore, women with FMS have impaired postural control that is worse when sensory inputs are altered but is not correlated with their lower limb strength.

Plasma Cytokine Levels in Fibromyalgia and Their Response to 15 Weeks of Progressive Resistance Exercise or Relaxation Therapy

The aims of this study were to compare circulating cytokines between FM and healthy controls and to investigate the effect on cytokine levels by 15 weeks of progressive resistance exercise or relaxation therapy in FM. Baseline plasma cytokine levels and clinical data were analyzed in 125 women with FM and 130 age-matched healthy women. The FM women were then randomized to progressive resistance exercise (n = 49) or relaxation (n = 43). Baseline IL-2, IL-6, TNF-α, IP-10, and eotaxin were higher in FM than in healthy controls (P < 0.041), whereas IL-1β was lower (P < 0.001). There were weak correlations between cytokine levels and clinical variables. After both interventions, IL-1ra had increased (P = 0.004), while IL-1β had increased in the relaxation group (P = 0.002). Changes of IFN-γ, IL-2, IL-4, IL-6, IL-8, and IL-17A were weakly correlated with changes of PPT, but there were no significant correlations between changes of cytokine and changes in other clinical variables. The elevated plasma levels of several cytokines supports the hypothesis that chronic systemic inflammation may underlie the pathophysiology of FM even if the relation to clinical variables was weak. However, 15 weeks of resistance exercise, as performed in this study, did not show any anti-inflammatory effect on neither FM symptoms nor clinical and functional variables. This trial is registered with ClinicalTrials.govNCT01226784, registered October 21, 2010. The first patient was recruited October 28, 2010.

Increased Interstitial Concentrations of Glutamate and Pyruvate in Vastus Lateralis of Women with Fibromyalgia Syndrome Are Normalized after an Exercise Intervention - A Case-Control Study

BACKGROUND

Fibromyalgia syndrome (FMS) is associated with central alterations, but controversies exist regarding the presence and role of peripheral factors. Microdialysis (MD) can be used in vivo to study muscle alterations in FMS. Furthermore for chronic pain conditions such as FMS, the mechanisms for the positive effects of exercise are unclear. This study investigates the interstitial concentrations of algesics and metabolites in the vastus lateralis muscle of 29 women with FMS and 28 healthy women before and after an exercise intervention.

METHODS

All the participants went through a clinical examination and completed a questionnaire. In addition, their pressure pain thresholds (PPTs) in their upper and lower extremities were determined. For both groups, MD was conducted in the vastus lateralis muscle before and after a 15-week exercise intervention of mainly resistance training of the lower limbs. Muscle blood flow and interstitial muscle concentrations of lactate, pyruvate, glutamate, glucose, and glycerol were determined.

RESULTS

FMS was associated with significantly increased interstitial concentrations of glutamate, pyruvate, and lactate. After the exercise intervention, the FMS group exhibited significant decreases in pain intensity and in mean interstitial concentrations of glutamate, pyruvate, and glucose. The decrease in pain intensity in FMS correlated significantly with the decreases in pyruvate and glucose. In addition, the FMS group increased their strength and endurance.

CONCLUSION

This study supports the suggestion that peripheral metabolic and algesic muscle alterations are present in FMS patients and that these alterations contribute to pain. After an exercise intervention, alterations normalized, pain intensity decreased (but not abolished), and strength and endurance improved, all findings that suggest the effects of exercise are partially peripheral.

Isokinetic Assessment of the Wrist Muscles in Females With Fibromyalgia

OBJECTIVES

This study aims to evaluate wrist muscle strength and muscle fatigue in females with fibromyalgia syndrome (FMS) and compare the results with those of healthy controls.

PATIENTS AND METHODS

Thirty consecutive female FMS patients (mean age 39.8±6.7 years; range 25 to 49 years) and 50 age and body mass index similar healthy females (mean age 35.4±7.9 years; range 27 to 48 years) were enrolled. Patients' clinical characteristics were recorded and symptoms were evaluated by the Fibromyalgia Impact Questionnaire. In addition to the demographic characteristics, physical activities of all subjects were questioned, isokinetic muscle performance was measured, and fatigue index was calculated by endurance test.

RESULTS

The peak torque values of the wrist extensor and flexor muscles (at an angular velocity of 90°/second) were higher in the control group than in the FMS group (both p<0.01). There were no differences between the groups in terms of the fatigue indexes of the flexor and extensor muscles of the wrist (both p>0.05). While there were differences between the groups regarding weekly hours of walking (p=0.01) and house cleaning (p<0.001), no differences were determined for weekly hours of bicycling, gardening, doing sports, or total physical activity. There was no correlation between the peak torque values and clinical characteristics in FMS group.

CONCLUSION

Patients with FMS had decreased muscle strength compared to healthy controls. Further studies with larger participants are needed to explain the relationship between upper limb muscle performance and FMS, as well as the underlying pathogenesis.

Fibromyalgia: A Critical and Comprehensive Review

Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.

Effects of 15 weeks of resistance exercise on pro-inflammatory cytokine levels in the vastus lateralis muscle of patients with fibromyalgia

Background

This study aimed at investigating the effect of a resistance exercise intervention on the interstitial muscle levels of pro-inflammatory cytokines in fibromyalgia (FMS) and healthy controls (CON).

Methods

Twenty-four female patients with FMS (54 ± 8 years) and 27 female CON (54 ± 9 years) were subjected to intramuscular microdialysis of the most painful vastus lateralis muscle before and after 15 weeks of progressive resistance exercise twice per week. Baseline dialysates were sampled in the resting muscle 140 min after insertion of the microdialysis catheter. The participants then performed repetitive dynamic contractions (knee extension) for 20 min, followed by 60 min rest. Pain intensity was assessed with a 0–100 mm visual analogue scale (VAS), and fatigue was assessed with Borg’s RPE throughout microdialysis. Dialysates were sampled every 20 min and analyzed with Luminex for interleukin (IL)-1β, tumor necrosis factor (TNF) alpha, IL-6, and IL-8.

Results

At both sessions and for both groups the dynamic contractions increased pain (P < 0.012) and fatigue (P < 0.001). The levels of TNF were lower in the FMS group than the CON group at both sessions (P < 0.05), but none of the other cytokines differed between the groups. IL-6 and IL-8 increased after the dynamic contractions in both groups (P < 0.010), while TNF increased only in CON (P < 0.05) and IL-1β did not change. Overall pain intensity was reduced after the 15 weeks of resistance exercise in FMS (P < 0.05), but there was no changes in fatigue or cytokine levels.

Conclusion

Progressive resistance exercise for 15 weeks did not affect the interstitial levels of IL-1β, TNF, IL-6, and IL-8 in the vastus lateralis muscle of FMS patients or CON.

Trial registration

Clinicaltrials.gov NCT01226784, registered 21 October 2010.

Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial

Background

Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-centeredness, to support each participant’s ability to manage the exercise and the progress of it. The aim of this sub-study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program.

Methods

A total of 67 women with FM were included in this sub-study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-related questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability.

Results

Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R² = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R² = 32, p = 0.025 and R² = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R² = 19, p = 0.001).

Conclusion

The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise.

The trial was registered on October 21, 2010 with ClinicalTrials.gov identification number: NCT01226784.

Pain severity is associated with muscle strength and peak oxygen uptake in adults with fibromyalgia

Background

The associations between pain, lower extremity strength, and aerobic conditioning have not been widely investigated in adults with fibromyalgia (FM). The principle objective of this study was to investigate the relationship between pain severity and knee strength in patients seeking treatment for FM. A secondary objective was to investigate the relationship between pain scores and aerobic conditioning.

Methods

Three measures of knee strength (isokinetic extensor, isokinetic flexor, isometric extensor) were quantified in the dominant leg of 69 adults with FM using a dynamometer at speeds of 60 degrees per second (60°/s) and 180°/s. Peak oxygen uptake (VO₂) was assessed using a cycle ergometer, and pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory.

Results

In univariable linear regression analyses using pain severity as the dependent variable, lesser values of isokinetic knee extensor strength at 60°/s (P=0.041) and 180°/s (P=0.010), isokinetic knee flexor strength at 60°/s (P=0.028) and 180°/s (P=0.003), and peak VO₂ uptake (P=0.031) were predictive of greater pain severity scores. In multiple variable linear regression models adjusted for age, sex, body mass index, and opioid use, the following associations retained statistical significance; isokinetic knee extensor strength at 60°/s (P=0.020) and 180°/s (P=0.003), isokinetic knee flexor strength at 60°/s (P=0.015) and 180°/s (P=0.001), and peak VO₂ uptake (P=0.014). However, no significant associations were found between pain severity and isometric knee extensor strength.

Conclusion

The main findings from this study were that lesser values of isokinetic knee strength and peak VO₂ uptake were predictive of greater pain severity scores. These results build on the findings of previous investigations, but ongoing research is needed to further characterize the effects of strength and peak VO₂ uptake on the pathophysiology of FM.

Strengthening exercises improve symptoms and quality of life but do not change autonomic modulation in fibromyalgia: a randomized clinical trial

Objective

Autonomic dysfunction is an important mechanism that could explain many symptoms observed in fibromyalgia (FM). Exercise is an effective treatment, with benefits potentially mediated through changes in autonomic modulation. Strengthening is one of the less studied exercises in FM, and the acute and chronic effects of strengthening on the autonomic system remain unknown. The objective of this study was to assess the chronic effects of strengthening exercises (STRE) on autonomic modulation, pain perception and the quality of life (QOL) of FM patients.

Methods

Eighty sedentary women with FM (ACR 1990) were randomly selected to participate in STRE or flexibility (FLEX) exercises in a blinded controlled trial. The intensity of STRE was set at 45% of the estimated load of 1 Repetition Maximum (RM) in 12 different exercises. Outcomes were Visual Analog Scale (VAS) for pain, Heart Rate Variability (HRV) analysis, treadmill test, the sit and reach test (Wells and Dillon’s Bench), maximal repetitions test and handgrip dynamometry; and quality of life by the Fibromyalgia Impact Questionnaire (FIQ), the Beck and Idate Trait-State Inventory (IDATE), a short-form health survey (SF-36).

Results

The STRE group was more effective to strength gain for all muscles and pain control after 4 and 16 weeks (p<0.05). The FLEX group showed higher improvements in anxiety (p<0.05). Both groups showed improvements in the QOL, and there was no significant difference observed between the groups. There was no change in the HRV of the STRE and FLEX groups.

Conclusions

Strengthening exercises show greater and more rapid improvements in pain and strength than flexibility exercises. Despite the benefits in fitness, pain, depression, anxiety and quality of life, no effect was observed on the autonomic modulation in both groups. This observation suggests that changes in autonomic modulation are not a target tobe clinically achieved in fibromyalgia.

Trial Registration

ClinicalTrials.gov NCT02004405

Isokinetic muscle performance of the hip and ankle muscles in women with fibromyalgia

OBJECTIVE

To compare isokinetic muscle performances of a proximal (hip) and a distal (ankle) muscle of fibromyalgia syndrome (FMS) patients with those of age- and body mass index (BMI)-matched healthy subjects.

METHODS

Thirty female patients with FMS (mean age: 41.5 ± 6.7 years [range, 27-54]) and 30 age- (mean age: 40.6 ± 6.0 years [range, 27-54]) and BMI-matched female healthy controls were consecutively enrolled. Demographic and clinical characteristics of the subjects were recorded. Isokinetic measurements of hip and ankle flexion and extension at angular velocities of 60°/s and 180°/s, peak torques, flexor-extensor torque ratios, muscle fatigue resistance values and average power were obtained.

RESULTS

Mean disease duration of FMS patients was 2.4 ± 1.9 years. Mean weight, height and BMI values were 70.4 ± 12.5 kg, 159.5 ± 6.0 cm and 27.7 ± 4.7 kg/m² (FMS patients) and 69.3 ± 10.1 kg, 161.7 ± 6.2 cm and 26.6 ± 4.3 kg/m² (control subjects), respectively (all P > 0.05). All isokinetic values were statistically decreased in the FMS group when compared with the control group, except for the peak torques at angular velocity of 180°/s on flexion of the hip and extension of the ankle and the total work and average power on extension of the ankle. We did not find any correlation between isokinetic values and disease related parameters of FMS patients.

CONCLUSIONS

In the light of our results, we may conclude that muscle strength and muscle fatigue seem to decrease in FMS patients' both proximal and distal lower extremity muscles.

Prior eccentric exercise augments muscle pain and perception of effort during cycling exercise

OBJECTIVES

This study examined the effects of exercise-induced muscle damage (EIMD) on the physiological and perceptual responses to 30 minutes of submaximal cycling at 60% of oxygen consumption (VO2 peak).

METHODS

Ten participants completed two 30-minute bouts of cycling, one before and one 48 hours after performance of strenuous (24 contractions with 120% of concentric 1-repeition maximum) eccentric exercise.

RESULTS

Eccentric exercise resulted in a significant delayed-onset muscle pain (1.6±1.6 mm to 44.8±20 mm on a 100-mm visual analog scale; P<0.001) and a 15% (P<0.001) reduction in maximal strength 48 hours after exercise. Ratings of quadriceps muscle pain (1.99±0.42 vs. 3.30±0.56; P=0.003) and perceived exertion (RPE; 13.0±0.30 vs. 13.8±0.61; P=0.02) were elevated during cycling after EIMD at identical work rates. No changes were observed in VO2 (29.6±4.6 vs. 30.2±4.4 mL/kg/min; P=0.41), heart rate (154±15 vs. 155±9 beats/min; P=0.58), and ventilation (57.2±12.1 vs. 59.8±12.7 L/min; P=0.13) during exercise after EIMD. The mean change in RPE was significantly correlated (r=0.56; P<0.01) with the change in muscle pain during cycling and delayed-onset pain during resistance exercise (r=0.86; P<0.01), but did not correlate with changes in VO2, heart rate, ventilation, and maximal strength.

DISCUSSION

These findings indicate the elevations in RPE after EIMD are likely a consequence of the EIMD with the most likely explanation being an increase in localized pain before and during cycling exercise.

Association of fibromyalgia with altered skeletal muscle characteristics which may contribute to postexertional fatigue in postmenopausal women

OBJECTIVE

To identify muscle physiologic properties that may contribute to postexertional fatigue and malaise in women with fibromyalgia (FM).

METHODS

Healthy postmenopausal women with (n = 11) and without (n = 11) FM, ages 51-70 years, participated in this study. Physical characteristics and responses to self-reported questionnaires were evaluated. Strength loss and tissue oxygenation in response to a fatiguing exercise protocol were used to quantify fatigability and the local muscle hemodynamic profile. Muscle biopsies were performed to assess between-group differences in baseline muscle properties using histochemical, immunohistochemical, and electron microscopic analyses.

RESULTS

There was no significant difference between healthy controls and FM patients in muscle fatigue in response to exercise. However, self-reported fatigue and pain were correlated with prolonged loss of strength following 12 minutes of recovery in patients with FM. Although there was no difference in percent succinate dehydrogenase (SDH)-positive (type I) and SDH-negative (type II) fibers or in mean fiber cross-sectional area between groups, FM patients exhibited greater variability in fiber size and altered fiber size distribution. In healthy controls only, fatigue resistance was strongly correlated with the size of SDH-positive fibers and hemoglobin oxygenation. In contrast, FM patients with the highest percentage of SDH-positive fibers recovered strength most effectively, and this was correlated with capillary density. However, overall, capillary density was lower in the FM group.

CONCLUSION

Peripheral mechanisms, i.e., altered muscle fiber size distribution and decreased capillary density, may contribute to postexertional fatigue in FM. Understanding of these defects in fibromyalgic muscle may provide valuable insight with regard to treatment.

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.

[Physiotherapy and physical therapies for fibromyalgia syndrome. Systematic review, meta-analysis and guideline]

BACKGROUND

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011.

MATERIALS AND METHODS

The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.

RESULTS AND CONCLUSION

Low-to-moderate intensity aerobic exercise and strength training are strongly recommended. Chiropractic, laser therapy, magnetic field therapy, massage and transcranial current stimulation are not recommended. The English full-text version of this article is available at SpringerLink (under "Supplemental").

Sex differences in exercise-induced muscle pain and muscle damage

There is uncertainty about sex differences in exercise-induced muscle pain and muscle damage due to several methodological weaknesses in the literature. This investigation tested the hypothesis that higher levels of exercise-induced muscle pain and muscle damage indicators would be found in women than men when several methodological improvements were executed in the same study. Participants (N = 33; 42% women) with an average age of 23 years (SD = 2.82) consented to participate. After a familiarization session, participants visited the laboratory before and across 4 days after eccentric exercise was completed to induce arm muscle pain and muscle damage. Our primary outcomes were arm pain ratings and pressure pain thresholds. However, we also measured the following indicators of muscle damage: arm girth; resting elbow extension; isometric elbow flexor strength; myoglobin (Mb); tumor necrosis factor (TNFa); interleukin 1beta (IL1b); and total nitric oxide (NO). Temporary induction of muscle damage was indicated by changes in all outcome measures except TNFa and IL1b. In contrast to our hypotheses, women reported moderately lower and less frequent muscle pain than men. Also, women's arm girth and Mb levels increased moderately less than men's, but the differences were not significant. Few large sex differences were detected.

PERSPECTIVE

Lower muscle pain among women than men was detected with corresponding, but nonsignificant sex differences in other muscle damage indicators. Methodological advances may have improved alignment of these results with the nonhuman animal findings. This line of research continues to show exceptions to the generalization that women experience greater pain than men.

Noninvasive optical characterization of muscle blood flow, oxygenation, and metabolism in women with fibromyalgia

Introduction

Women with fibromyalgia (FM) have symptoms of increased muscular fatigue and reduced exercise tolerance, which may be associated with alterations in muscle microcirculation and oxygen metabolism. This study used near-infrared diffuse optical spectroscopies to noninvasively evaluate muscle blood flow, blood oxygenation and oxygen metabolism during leg fatiguing exercise and during arm arterial cuff occlusion in post-menopausal women with and without FM.

Methods

Fourteen women with FM and twenty-three well-matched healthy controls participated in this study. For the fatiguing exercise protocol, the subject was instructed to perform 6 sets of 12 isometric contractions of knee extensor muscles with intensity steadily increasing from 20 to 70% maximal voluntary isometric contraction (MVIC). For the cuff occlusion protocol, forearm arterial blood flow was occluded via a tourniquet on the upper arm for 3 minutes. Leg or arm muscle hemodynamics, including relative blood flow (rBF), oxy- and deoxy-hemoglobin concentration ([HbO₂] and [Hb]), total hemoglobin concentration (THC) and blood oxygen saturation (StO₂), were continuously monitored throughout protocols using a custom-built hybrid diffuse optical instrument that combined a commercial near-infrared oximeter for tissue oxygenation measurements and a custom-designed diffuse correlation spectroscopy (DCS) flowmeter for tissue blood flow measurements. Relative oxygen extraction fraction (rOEF) and oxygen consumption rate (rVO₂) were calculated from the measured blood flow and oxygenation data. Post-manipulation (fatiguing exercise or cuff occlusion) recovery in muscle hemodynamics was characterized by the recovery half-time, a time interval from the end of manipulation to the time that tissue hemodynamics reached a half-maximal value.

Results

Subjects with FM had similar hemodynamic and metabolic response/recovery patterns as healthy controls during exercise and during arterial occlusion. However, tissue rOEF during exercise in subjects with FM was significantly lower than in healthy controls, and the half-times of oxygenation recovery (Δ[HbO₂] and Δ[Hb]) were significantly longer following fatiguing exercise and cuff occlusion.

Conclusions

Our results suggest an alteration of muscle oxygen utilization in the FM population. This study demonstrates the potential of using combined diffuse optical spectroscopies (i.e., NIRS/DCS) to comprehensively evaluate tissue oxygen and flow kinetics in skeletal muscle.

Functional capacity, muscle strength and falls in women with fibromyalgia

BACKGROUND

Patients with fibromyalgia have difficulty with activities of daily living, they exhibit reduced muscle strength and high incidence of reported falls. The objective of this study was to evaluate the functional performance and lower limb muscle strength in women with fibromyalgia and determine the relationship between muscle strength and falls.

METHODS

Sixteen females with fibromyalgia and 16 healthy women participated in the study. Pain intensity, fibromyalgia impact on quality of life, physical activity level and fall prevalence were assessed. The peak torque and the rate of torque development were determined in maximal voluntary isometric contraction (hip, knee and ankle joints) using a load cell. The 30s chair stand, 8 ft up and go, sit and reach, and functional reach tests were used to characterize functional performance.

FINDINGS

Women with fibromyalgia showed deficits in lower limb muscle strength, balance and agility and exhibited decreased knee extension peak torque and rate of torque development. In addition, they showed lower hip adduction and extension peak torque in comparison to the control group (P>0.05). Hip extension rate of torque development, duration of fibromyalgia symptoms, overall pain, knee pain, and fibromyalgia impact were strong predictors of the number of falls in patients with fibromyalgia (R2=0.86; P<0.05), when considered collectively.

INTERPRETATION

Women with fibromyalgia showed reduced functional performance and lower limb muscle strength, mostly explained by pain. There was a high prevalence of falls in this population, as explained by hip extensors rate of torque development, duration of fibromyalgia symptoms and pain.

Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: a randomized equivalence trial

Strength training and aerobic exercise have beneficial effects on pain in adults with fibromyalgia. However, the equivalence of strengthening and aerobic exercise has not been reported. The primary aim of this randomized equivalence trial involving patients with fibromyalgia admitted to an interdisciplinary pain treatment program was to test the hypothesis that strengthening (n=36) and aerobic (n=36) exercise have equivalent effects (95% confidence interval within an equivalence margin ± 8) on pain, as measured by the pain severity subscale of the Multidimensional Pain Inventory. Secondary aims included determining the effects of strengthening and aerobic exercise on peak Vo(2) uptake, leg strength, and pressure pain thresholds. In an intent-to-treat analysis, the mean (± standard deviation) pain severity scores for the strength and aerobic groups at study completion were 34.4 ± 11.5 and 37.6 ± 11.9, respectively. The group difference was -3.2 (95% confidence interval, -8.7 to 2.3), which was within the equivalence margin of Δ8. Significant improvements in pain severity (P<.001), peak Vo(2) (P<.001), strength (P<.001), and pain thresholds (P<.001) were observed from baseline to week 3 in the intent-to-treat analysis; however, patients in the aerobic group (mean change 2.0 ± 2.6 mL/kg/min) experienced greater gains (P<.013) in peak Vo(2) compared to the strength group (mean change 0.4 ± 2.6 mL/kg/min). Knowledge of the equivalence and physiological effects of exercise have important clinical implications that could allow practitioners to target exercise recommendations on the basis of comorbid medical conditions or patient preference for a particular type of exercise. This study found that strength and aerobic exercise had equivalent effects on reducing pain severity among patients with fibromyalgia.

Resistance exercise training does not affect postexercise hypotension and wave reflection in women with fibromyalgia

The purpose of this study was to assess the effects of resistance exercise training (RET) on aortic wave reflection and hemodynamics during recovery from acute resistance exercise in women with fibromyalgia (FM) and healthy women (HW). Nine women with FM (aged 42 ± 5 years; mean ± SD) and 14 HW (aged 45 ± 5 years) completed testing at baseline and after 12 weeks of whole-body RET that consisted of 3 sets of 5 exercises. Heart rate (HR), digital blood pressure (BP, plethysmography), aortic BP, and wave reflection (radial tonometry) were assessed before and 20 min after acute leg resistance exercise. Aortic and digital diastolic blood pressure (DBP) were significantly decreased (p < 0.05) and aortic and digital pulse pressures (PP) were significantly increased (p < 0.05) after acute exercise before RET. Acute resistance exercise had no effect on HR, wave reflection (augmentation index and reflection time), digital, or aortic systolic BP. RET improved muscle strength without affecting acute DBP and PP responses. Acute resistance exercise produces postexercise diastolic hypotension without affecting systolic blood pressure, HR, and wave reflection responses in women with and without FM. RET does not alter resting and postexercise hemodynamics and aortic wave reflection in premenopausal women.

Strength training as a countermeasure to aging muscle and chronic disease

Strength training (ST) has long been considered a promising intervention for reversing the loss of muscle function and the deterioration of muscle structure associated with advanced age but, until recently, the evidence was insufficient to support its role in the prevention or treatment of disease. In recent decades, there has been a long list of quality reviews examining the effects of ST on functional abilities and a few on risk factors for specific diseases, but none have provided a comprehensive assessment of ST as an intervention for a broad range of diseases. This review provides an overview of research addressing the effectiveness of ST as an intervention for the prevention or treatment of the adverse consequences of (i) aging muscle; (ii) the metabolic syndrome (MetS) and its components, i.e. insulin resistance, abdominal obesity, hyperlipidaemia and hypertension; (iii) fibromyalgia; (iv) rheumatoid arthritis; and (v) Alzheimer's disease. Collectively, these studies indicate that ST may serve as an effective countermeasure to some of the adverse consequences of the MetS, fibromyalgia and rheumatoid arthritis. Evidence in support of the hypothesis that ST reduces insulin resistance or improves insulin action comes both from indirect biomarkers, such as glycosylated haemoglobin (HbA(1c)), and insulin responses to oral glucose tolerance tests, as well as from more direct procedures such as hyperglycaemic and hyperinsulinaemic-euglycaemic clamp techniques. The evidence for the use of ST as a countermeasure of abdominal obesity is less convincing. Although some reports show statistically significant reductions in visceral fat, it is unclear if the magnitude of these changes are physiologically meaningful and if they are independent of dietary influences. The efficacy of ST as an intervention for reducing dyslipidaemia is at best inconsistent, particularly when compared with other pharmacological and non-pharmacological interventions, such as aerobic exercise training. However, there is more consistent evidence for the effectiveness of ST in reducing triglyceride levels. This finding could have clinical significance, given that elevated triglyceride is one of the five criterion measures for the diagnosis of the MetS. Small to moderate reductions in resting and exercise blood pressure have been reported with some indication that this effect may be genotype dependent. ST improves or reverses some of the adverse effects of fibromyalgia and rheumatoid arthritis, particularly pain, inflammation, muscle weakness and fatigue. Investigations are needed to determine how these effects compare with those elicited from aerobic exercise training and/or standard treatments. There is no evidence that ST can reverse any of the major biological or behavioural outcomes of Alzheimer's disease, but there is evidence that the prevalence of this disease is inversely associated with muscle mass and strength. Some indicators of cognitive function may also improve with ST. Thus, ST is an effective countermeasure for some of the adverse effects experienced by patients of many chronic diseases, as discussed in this review.

Fatigue in systemic lupus erythematosus: an association with reduced physical fitness

Systemic lupus erythematosus (SLE) is an autoimmune disease that is characterized by fatigue; however, little research has been performed to identify non-pharmacological strategies, such as physical exercise, that can be employed in the prevention and treatment of fatigue in patients with SLE. Moreover, it is not clear whether physical fitness (defined here as cardiovascular fitness and muscle strength) and functional capacities are related to SLE-associated fatigue. Here, we review the studies, mechanisms and results that relate to SLE-associated fatigue. The main findings indicate that SLE patients have lower cardiovascular capacity than healthy subjects. Physical fitness, muscle strength and functional capacity are also lower in patients with SLE than in healthy individuals. The effects of exercise programs in reducing symptoms of fatigue in SLE patients remain unclear.

Pressure and activity-related allodynia in delayed-onset muscle pain

OBJECTIVES

Muscle pain from different activities was tested with the muscle pain expected to vary in ways that may clarify mechanisms of activity-induced exacerbation of myofascial pain.

METHODS

Participants [N=20; 45% women; 23 y old (SD=2.09)] consented to participate in a 6 session protocol. Bilateral muscle pain ratings and pressure pain thresholds (PPTs) were collected before and for 4 days after lengthening (ie, eccentric) muscle contractions were completed with the nondominant elbow flexors to induce delayed-onset muscle pain. The muscle pain ratings were collected with the arms in several conditions (eg, resting, moving, and contracting in a static position) and PPTs were collected with the arms.

RESULTS

In the ipsilateral arm, muscle pain ratings at rest and during activity significantly increased whereas PPTs significantly decreased after the eccentrics (ηs=0.17 to 0.54). The greatest increases in pain occurred during arm extension without applied load, in which there was more stretching but less force than isometrics. In the contralateral arm, neither muscle pain nor PPTs changed from baseline.

DISCUSSION

These results resemble earlier electrophysiology studies showing differential sensitization across stimuli and support that increased depth of information about aggravating activities from clinical patients is needed.

Pain variability in fibromyalgia is related to activity and rest: role of peripheral tissue impulse input

Because fibromyalgia (FM) patients frequently report activity-dependent deep tissue pains, impulse input from painful body regions may be relevant for their musculoskeletal complaints. In addition, peripheral impulse input may induce and maintain thermal and mechanical hyperalgesia of FM patients. If so, activity and rest may alternately enhance and diminish intensity of FM pain. However, the effects of exercise on pain are ambiguous in studies of FM. Whereas exercise-only studies demonstrated increased pain and hyperalgesia during and after physical activity, some exercise studies that included rest periods resulted in decreased FM pain and increased function. To further clarify these effects, we examined the effects of alternating exercise with rest on clinical pain and thermal/mechanical hyperalgesia of 34 FM patients and 36 age-matched healthy controls (NC). Using an ergometer, all subjects performed arm exercise to exhaustion twice alternating with 15-minute rest periods. Although strenuous muscle activity was reported as painful by most FM subjects, overall clinical pain consistently decreased during the rest periods. Additionally, FM subjects' pain sensitivity to mechanical pressure decreased after each exercise and rest session.

CONCLUSION

Alternating strenuous exercise with brief rest periods not only decreased overall clinical pain of FM subjects but also their mechanical hyperalgesia. No prolonged worsening of overall FM pain and hyperalgesia occurred despite vigorous muscle activity. Our findings contribute further evidence that FM pain and hyperalgesia are at least partially maintained by muscle impulse input, and that some types of exercises may be beneficial for FM.

PERSPECTIVE

FM is a pain-amplification syndrome that depends at least in part on peripheral tissue impulse input. Whereas muscle activity increased overall pain, short rest periods produced analgesic effects.

The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia

OBJECTIVE

To determine the effects of 12 weeks of resistance exercise training (RET) on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia (FM) and healthy controls (HCs).

DESIGN

Before-after trial.

SETTING

Testing and training occurred in a university setting.

PARTICIPANTS

Women with FM (n=9; mean age ± SD, 42±5y) and HCs (n=15; mean age, 45±5y).

INTERVENTION

Both groups underwent testing before and after 12 weeks of whole-body RET consisting of 3 sets of 8 to 12 repetitions on 5 different exercises.

MAIN OUTCOME MEASURES

Disease severity was assessed using the number of active tender points, myalgic score, and the Fibromyalgia Impact Questionnaire (FIQ). Heart rate and autonomic modulation using power spectral analysis of heart rate variability (HRV) were measured at rest and 20 minutes after 5 sets of leg-press exercise.

RESULTS

There was no group-by-time interaction for any variable. Women with FM and HCs had similar increases in maximal strength (P<.05) after RET. Number of active tender points, myalgic score, and FIQ score were decreased (P<.05) after RET in women with FM. Heart rate and natural log (Ln) high frequency (LnHF) were recovered, whereas Ln low frequency (LnLF) and LnLF/LnHF ratio were increased (P<.05) 20 minutes after acute leg resistance exercise. There were no significant effects of RET on HRV at rest or postexercise.

CONCLUSIONS

These findings indicate that cardiovagal modulation of heart rate recovers early after leg resistance exercise in women with FM and HCs. It is concluded that RET reduces the severity of FM, but it has no impact on autonomic modulation of heart rate.

A randomized trial of tai chi for fibromyalgia

BACKGROUND

Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia.

METHODS

We conducted a single-blind, randomized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia (defined by American College of Rheumatology 1990 criteria). Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the study groups. The primary end point was a change in the Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 to 100, with higher scores indicating more severe symptoms) at the end of 12 weeks. Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). All assessments were repeated at 24 weeks to test the durability of the response.

RESULTS

Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (+/-SD) baseline and 12-week FIQ scores for the tai chi group were 62.9+/-15.5 and 35.1+/-18.8, respectively, versus 68.0+/-11 and 58.6+/-17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group, -18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5+/-8.4 and 37.0+/-10.5 for the tai chi group versus 28.0+/-7.8 and 29.4+/-7.4 for the control group (between-group difference, 7.1 points; P=0.001), and the mental-component scores were 42.6+/-12.2 and 50.3+/-10.2 for the tai chi group versus 37.8+/-10.5 and 39.4+/-11.9 for the control group (between-group difference, 6.1 points; P=0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, -18.3 points; P<0.001). No adverse events were observed.

CONCLUSIONS

Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations. (Funded by the National Center for Complementary and Alternative Medicine and others; ClinicalTrials.gov number, NCT00515008.)

Fibromyalgia syndrome: a discussion of the syndrome and pharmacotherapy

Fibromyalgia is a complex condition that is characterized by chronic widespread pain and multiple other symptoms, including fatigue, sleep disturbances, cognitive dysfunction, stiffness, and depressive episodes. Fibromyalgia may coexist and/or overlap with other conditions that may involve central sensitivity, including chronic fatigue syndrome, irritable bowel syndrome, irritable bladder syndrome or interstitial cystitis, and temporomandibular disorder. The pathophysiology of fibromyalgia remains uncertain but is believed to be partly the result of central systems affecting afferent processing as well as impaired endogenous pain-inhibitory systems. Abnormal central nociceptive processing may contribute to fibromyalgia, producing heightened responses to various noxious stimuli with resulting mechanical hyperalgesia. Fibromyalgia remains a clinical diagnosis. There has been a recent paradigm shift away from requiring 11 or more out of 18 tender points and instead focusing on the presence of chronic widespread pain as well as symptoms of fatigue, unrefreshed sleep, and other somatic complaints. Although there is no known cure for fibromyalgia, multidisciplinary team efforts using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy, and pharmacologic therapies (serotonin norepinephrine reuptake inhibitors [eg, duloxetine, milnacipran] and alpha 2-delta receptor ligands [eg, pregabalin]) may improve symptoms as well as function of patients with fibromyalgia.

Exercise interventions in fibromyalgia: clinical applications from the evidence

This article summarizes physiologic obstacles to exercise and reviews exercise interventions in fibromyalgia (FM). In addition, the authors describe the top 10 principles for successfully prescribing exercise in the comprehensive treatment of FM and provide a practical exercise resource table to share with patients. A therapeutic alliance between the provider and patient is enhanced if both understand the risks and benefits of exercise. Such an alliance increases the likelihood of the patient successfully integrating life-long exercise into his or her comprehensive FM treatment plan.

Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia: a cohort study

OBJECTIVE

To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength.

METHODS

A total of 840 FM patients and 122 healthy subjects were evaluated between 1998 and 2005. All of the patients completed version 1 of the Fibromyalgia Impact Questionnaire (FIQ) and were assessed for tender points and knee muscle strength. All subjects underwent bilateral isokinetic knee muscle strength testing in flexion and extension. Normative knee muscle strength values were calculated from the healthy subjects, and the FM cohort was divided in 2 groups: 1) patients with normal muscle strength and 2) patients with low muscle strength (2 SDs below normal). The clinical characteristics of these 2 groups were compared.

RESULTS

Significantly reduced knee muscle strength was found in 52% of the patients. There were no clinically significant differences between patients with low versus normal muscle strength. There were no clinically significant correlations between total FIQ score, tender point count, and muscle strength. Only 4.6% of the FIQ scores and 5.1% of the tender point counts were explained by muscle strength.

CONCLUSION

Significantly reduced knee muscle strength was found in more than half of the patients. Patients with subnormal muscle strength were not more symptomatic or tender than patients with normal muscle strength. There were no clinically significant correlations between FIQ, tender point count, and muscle strength; therefore, reduced knee muscle strength appears to be a common objective abnormality in FM that is independent of measurements of disease activity. The implication of this finding in regard to the clinical assessment of FM needs further study.

Myotonic dystrophy type 2 found in two of sixty-three persons diagnosed as having fibromyalgia

Because of its high prevalence, fibromyalgia (FM) is a major general health issue. Myotonic dystrophy type 2 (DM2) is a recently described autosomal-dominant multisystem disorder. Besides variable proximal muscle weakness, myotonia, and precocious cataracts, muscle pain and stiffness are prominent presenting features of DM2. After noting that several of our mutation-positive DM2 patients had a previous diagnosis of FM, suggesting that DM2 may be misdiagnosed as FM, we invited 90 randomly selected patients diagnosed as having FM to undergo genetic testing for DM2. Of the 63 patients who agreed to participate, 2 (3.2%) tested positive for the DM2 mutation. Their cases are described herein. DM2 was not found in any of 200 asymptomatic controls. We therefore suggest that the presence of DM2 should be investigated in a large sample of subjects diagnosed as having FM, and clinicians should be aware of overlap in the clinical presentation of these 2 distinct disorders.

Effects of postpartum exercise program on fatigue and depression during "doing-the-month" period

This study explored the effectiveness of an exercise program on reducing levels of fatigue and depression among postpartum women who were "doing-the-month" in a maternity center in Taiwan. Previous studies related to postpartum have focused on depression rather than women's feelings of fatigue, and no study related to exercise has previously been conducted in a Taiwan maternity center. A low-intensity exercise program was specifically designed and administered to 31 subjects in the study's intervention group. Another 30 subjects (the control group) followed a traditional, non-physically active postpartum care regimen. Those in the intervention group were required to participate in at least 6 exercise program sessions during their one month postpartum stay. All subjects were asked to fill out a fatigue and depression questionnaire before and after the program. A Fatigue Symptom Checklist (FSC) was used to measure fatigue, and the Center for Epidemiological Studies Depression (CESD) was used to confirm the development of depression. Results showed statistically significant differences between the two groups in terms of fatigue levels, with statistical improvements (p < .05) registered by the intervention group in terms of levels of physical and psychological fatigue and fatigue symptoms. However, no significant changes in depression between the two groups were found. Study results demonstrate that a low-intensity exercise program can offer a good platform for clinicians and researchers to help reduce fatigue in postpartum women.

Non-pharmacological management of musculoskeletal disease in primary care

Musculoskeletal diseases as a group are one of the most common causes of contact in primary care and the most common causes of disability and long-term sick leave in several Western countries. Pain and dysfunction are often present without any specific findings in the musculoskeletal system, and a strictly biomedical approach is often inadequate. Body structure and function interact with personal and environmental factors, affecting the ability to perform activities and participate in society. It is important to meet these needs in primary care, and non-pharmacological principles such as physical activity and patient education with a cognitive approach are cornerstones in a multimodal management model.

An exploration of the association between frailty and muscle fatigue

Frailty is increasingly recognized as a geriatric syndrome that shares common biomedical determinants with rapid muscle fatigue: aging, disease, inflammation, physical inactivity, malnutrition, hormone deficiencies, subjective fatigue, and changes in neuromuscular function and structure. In addition, there is an established relationship between muscle fatigue and core elements of the cycle of frailty as proposed by Fried and colleagues (sarcopenia, neuroendocrine dysregulation and immunologic dysfunction, muscle weakness, subjective fatigue, reduced physical activity, low gait speed, and weight loss). These relationships suggest that frailty and muscle fatigue are closely related and that low tolerance for muscular work may be an indicator of frailty phenotype.

Ottawa Panel evidence-based clinical practice guidelines for strengthening exercises in the management of fibromyalgia: part 2

BACKGROUND AND PURPOSE

The objective of this study was to create guidelines for the use of strengthening exercises in the management of adult patients (>18 years of age) with fibromyalgia (FM), as defined by the 1990 American College of Rheumatology criteria.

METHODS

Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 5 randomized controlled trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found.

RESULTS

There were 5 positive recommendations: 2 grade A and 3 grade C+. All 5 were of clinical benefit.

DISCUSSION AND CONCLUSION

The Ottawa Panel recommends strengthening exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.