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Effectiveness of high-intensity interval training versus moderate-intensity continuous training in patients with fibromyalgia: A pilot randomized controlled trial
Abstract
Objective
To compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) combined with strengthening and stretching exercises in patients with fibromyalgia.
Design
Interventional, single-blinded, randomized-controlled trial.
Setting
Outpatient rehabilitation center.
Participants
Sixty women diagnosed with fibromyalgia were randomized to HIIT, MICT and Control groups.
Interventions
HIIT included a 5-min warm-up at 50% of peak-HR, four cycles of 4-min at 80–95% of peak-HR followed by 3-min recovery intervals at 70% of peak-HR. MICT consisted of 45-min at 65-70% of peak-HR. Each aerobic training session was followed by standardized strengthening and stretching exercises. The programs performed using cycle-ergometers 5-sessions per-week for 6-weeks. The control group did not participate in any supervised exercise sessions.
Main Outcome Measures
The primary outcome measure was the Fibromyalgia Impact Questionnaire (FIQ). The secondary outcome measures were visual analogic scale for pain, Short Form Health Survey-36 (SF-36), cardiopulmonary exercise test (CPET) and body composition parameters.
Results
Fifty-five participants completed the study. There was no significant difference in FIQ between HIIT vs MICT (1.03; 95% confidence interval (CI) -9.67 to 11.75) after treatment. Group-time interactions were significant for the FIQ between interventions and control (HIIT vs Control -16.20; 95% CI -27.23 to -5.13 and MICT vs Control -17.24; 95% CI -28.27 to -6.22) (all P<0.001). There were significant group-time interactions for the pain, SF-36 and CPET parameters between treatments and control (all P<0.05). Body-weight, fat-percentage, fat-mass and body mass index improved significantly (all P<0.05) only in MICT group after treatment.
Conclusions
The HIIT plus strengthening and stretching exercises and MICT plus strengthening and stretching exercises interventions showed significant improvements for the impact of fibromyalgia, pain degree, functional capacity and quality of life compared to the control group. HIIT was not superior to MICT. Furthermore, body composition parameters were improved significantly only for the MICT.
... Studies conducted in recent years focus on high intensity interval training (HIIT). HIIT are shorter in duration compared to moderate intensity continuous training (MICT) and produce the same or more positive effects compared to MICT (5). Compared to lower extremity training, upper extremity HIIT training has received relatively less attention in studies. ...
... Blood samples for biochemical analysis was performed by a responsible nurse. Biochemical analyzes were completed by the responsible physician (5). Biochemical analyzes such as MDA, myeloperoxidase (MPO), SOD, glutathione peroxidase (GSH-Px), 25-OH Vit D, free serum tryptophan, 5 hydroxyindoleacetic acid 5-HIAA were determined in the study. ...
... In the results of our biochemical analysis, no statistically significant difference was observed regarding the serotonergic system and vitamin D, but there were significant differences in oxidative stress in the exercise groups. (5,18). Oxidative stress is very important in the pathophysiology of FMS. ...
Purpose: The aim of this study was to evaluate the effect of telerehabilitation-based high intensity interval training (HIIT) on biochemistry parameters and disease symptoms in fibromyalgia patients. Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disease of unknown etiology accompanied by symptoms such as pain, hyperalgesia, sleep disorders, fatigue and mood disorders. Material and Methods: 33 fibromyalgia patients were randomly assigned as HIIT (n = 11), moderate-intensity continuous training (MICT)(n = 11) and control group (CG)(n = 11). While the patients in the study groups were given upper extremity exercise with telerehabilitation for 6 weeks, no intervention was applied to the CG. Disease symptoms and blood parameters were evaluated before and after treatment. Results: After the treatment, significant changes were found in the results of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase GSH(Px), right hand grip strength, pressure pain threshold, fatigue severity and disability in the HIIT group, and in the results of SOD, myeloperoxidase (MPO), left hand grip strength and fatigue severity in the MICT group (p
... El siguiente paso fue la lectura crítica de los resúmenes, en la cual se descartaron 42 artículos por no cumplir con los criterios de inclusión y exclusión, obteniendo como muestra total a siete artículos (cuatro de PubMed, uno de Cochrane Library y dos de WOS). (64)(65)(66)(67)(68)(69)(70) . ...
... Se identificó una variedad de tipos de actividad física, cada uno distinto del otro. Estos incluyeron HIIT (64) , entrenamiento continuo de intensidad moderada (MICT, por sus siglas en inglés) (64) , ejercicios de resistencia y coordinación (65) , estiramientos (66) , fuerza (66) , ejercicio de baja intensidad (67) , ejercicios de movilidad y coordinación (68) , ejercicios tradicionales chinos para el bienestar (Qi Gong) (68) , ejercicios de estiramiento y coordinación (69) y entrenamiento físico acuático (70) . ...
... Se identificó una variedad de tipos de actividad física, cada uno distinto del otro. Estos incluyeron HIIT (64) , entrenamiento continuo de intensidad moderada (MICT, por sus siglas en inglés) (64) , ejercicios de resistencia y coordinación (65) , estiramientos (66) , fuerza (66) , ejercicio de baja intensidad (67) , ejercicios de movilidad y coordinación (68) , ejercicios tradicionales chinos para el bienestar (Qi Gong) (68) , ejercicios de estiramiento y coordinación (69) y entrenamiento físico acuático (70) . ...
La fibromialgia es un síndrome que produce dolor muscular generalizado y difuso acompañado de fatiga, aunque también aparecen diversos síntomas, como depresión, ansiedad, alteración del sueño y del descanso, alodinia, problemas cognitivos, psicológicos y sociales. Esta sintomatología ocasiona que la calidad de vida de los pacientes se vea altamente afectada. Las formas de presentación de la patología aumentan la dificultad para el diagnóstico y el tratamiento de los profesionales que abordan a estos pacientes, para lo que destaca una prevalencia de 21:1 a favor de las mujeres sobre los hombres. Por otro lado, esta enfermedad conlleva un coste económico alto, pues 2/3 de los gastos no se invierten directamente para tratar la patología, por lo que se consideran perdidos. El objetivo de esta revisión es demostrar la eficacia de la adición de diferentes tratamientos activos, en comparación con el tratamiento farmacológico usual, en cuanto a la mejora de la calidad de vida y la reducción del dolor y la depresión en mujeres con fibromialgia. Para ello, se emplearon las bases de datos WOS, Cochrane Library y PubMed. Se seleccionaron siete artículos cuyo objetivo fue analizar la eficacia y seguridad del ejercicio terapéutico, una herramienta altamente costo-efectiva, como parte del tratamiento en mujeres con fibromialgia. Se seleccionaron ensayos clínicos con, al menos, un grupo de intervención que realizaba algún tipo de actividad física. Los artículos indicaron que el ejercicio físico como terapia añadida tiene beneficios en la calidad de vida, el alivio del dolor y la disminución de la depresión en mujeres con fibromialgia en comparación con aquellos grupos que simplemente seguían el tratamiento usual. Por ello, podemos concluir que el tratamiento usual (basado en fármacos), acompañado de un tratamiento activo, presenta mayores beneficios en las tres dimensiones ya mencionadas si lo comparamos con el tratamiento exclusivamente con fármacos. El tratamiento activo se considera seguro si deseamos añadirlo a la caja de herramientas que tenemos para tratar la sintomatología de la fibromialgia. Dependiendo de la sintomatología del paciente, y de sus gustos y preferencias, podríamos recomendarle o pautarle distintos tipos de actividad física para así favorecer su adherencia e individualizar cada caso.
... Therefore, it is conceivable that patients with unspecific MSDs may associate high-intensity exercise with pain, and consequently hesitate to engage in such exercises (Palstam et al., 2016;Pocovi et al., 2023). Yet, contrary to these common beliefs, laboratory trials have demonstrated that both HIIT and (relatively) high-intensity strength training seem to be both safe and feasible for patients with various unspecific MSDs (Atan et al., 2020;Cerini et al., 2022;Verbrugghe et al., 2019;Vilarino et al., 2023). ...
... However, it is worth noting that there is a lack of studies applying MST (i.e., ≥90% 1RM) in this population. Moreover, there are contradicting findings or low quality of evidence for any differences in subjective health-related outcomes and compliance when applying high-intensity training compared to more conventional treatments or moderate exercise in patients with fibromyalgia (Atan et al., 2020;Vilarino et al., 2023) and chronic low back pain (Cerini et al., 2022;Verbrugghe et al., 2019). ...
... A high aerobic intensity ensures that the cardiac output of the heart is targeted , and such intervals are recently documented to be superior to intervals with even higher overall intensity both in terms of increasing V̇O 2max and safety Hov et al., 2023). In contrast to our findings, there are previous reports of similar efficacy of high-and moderate-intensity training in patients with fibromyalgia (Atan et al., 2020). A possible reasons for this discrepancy between studies is that Atan and Karavelioğlu (Atan et al., 2020) applied a somewhat lower exercise intensity (>80% of HR max ) in their HIIT-group, yet a sufficiently high aerobic intensity is crucial to effectively overload the oxygen transport system and induce superior improvements compared to moderate continuous training (Helgerud et al., 2007;Wenger et al., 1986). ...
Improving peak oxygen uptake (V̇O2peak) and maximal strength are key objectives of rehabilitation for patients with unspecific musculoskeletal disorders (MSDs). Although high‐intensity training yield superior outcomes for these factors, patients with MSDs may not tolerate high‐intensity due to pain and fear. Therefore, we examined the effect and feasibility of incorporating aerobic high‐intensity intervals (HIITs) and maximal strength training (MST) in a standard clinical rehabilitation program for patients with unspecific MSDs. 73 patients (45 ± 10 years) with MSDs partaking in a standard, public, and 4‐week rehabilitation program were randomized to high‐intensity training (HG: 4 × 4 minutes intervals at ∼90% of maximal heart rate; HRmax, and 4 × 4 repetitions leg press at ∼90% of 1 repetition maximum; 1RM, with maximal intended velocity) or keep todays treatment of low‐to moderate‐intensity training (MG: various cycling, walking, and/or running activities at ∼70%–80% of HRmax and 3 × 8 − 10 repetitions leg press at ∼75% of 1RM without maximal intended velocity). HG improved V̇O2peak (12 ± 7%) and leg press 1RM (43 ± 34%) more than moderate‐intensity group (V̇O2peak; 5 ± 6%, 1RM; 19 ± 18%, both p < 0.001). We observed that no adverse events and no between‐group differences in dropout rate or self‐reported quality of life (both p > 0.05). There were positive correlations between improved V̇O2peak and improved physical (p = 0.024) and emotional (0.016) role functioning. We conclude that both high‐intensity interval training and MST are feasible and improve V̇O2peak and maximal strength more than standard low‐to moderate‐intensity treatment of patients with unspecific MSDs. Our findings suggest that high‐intensity training should be implemented as a part of standard clinical care of this patient population.
... Fibromyalgia (FM) is defined as a chronic rheumatic disease and is characterised by chronic widespread pain, muscle stiffness, sleep disturbances and cognitive problems [1][2][3][4]. In addition to these, the following symptoms are also observed: a feeling of fatigue and changes in the psychological state [5]. ...
... Most of the time, the diagnosis is quite difficult to perform because there is no accurate (i.e., validated) diagnostic test to identify the disease. Thus, the diagnosis of this disease is carried out through palpation from tender points specific for FM [1]. ...
... This systematic review aimed to analyse and systematise the characteristics of combined training programs and their effects in individuals diagnosed with Fibromyalgia. In the studies that were analysed, significant values were found for at least one of the evaluated parameters in all studies: (i) physical fitness tests [1,23,33,36,37,[39][40][41]; (ii) decreased symptoms and impact of FM on participants [1,5,15,17,23,33,36,37,41]; (iii) lower limb strength [1,15,33]. These results are in line with other authors who claim that physical exercise programs are important stimuli with positive influence, attenuating the symptoms of the disease, through changes in the hypothalamic-pituitary-adrenal axis (HPA)-resulting in the release of neurotransmitters due to exercise and controlling and/or reducing localised pain [16,42]. ...
Fibromyalgia is a rheumatic disease characterised by chronic widespread muscular pain and its treatment is carried out by pharmacological interventions. Physical exercise and a healthy lifestyle act as an important mechanism in reducing the symptoms of the disease. The aims of this study were to analyse and systematise the characteristics of combined training programs (i.e., type and duration of interventions, weekly frequency, duration and structure of training sessions and prescribed intensities) and to analyse their effects on people diagnosed with fibromyalgia. A systematic literature search was performed using the PRISMA method and then randomised controlled trial articles that met the eligibility criteria were selected. The Physiotherapy Evidence Database scale was used to assess the quality and risk of the studies. A total of 230 articles were selected, and in the end, 13 articles met the defined criteria. The results showed different exercise interventions such as: combined training, high-intensity interval training, Tai Chi, aerobic exercise, body balance and strength training. In general, the different interventions were beneficial for decreasing physical symptoms and improving physical fitness and functional capacity. In conclusion, a minimum duration of 14 weeks is recommended for better benefits. Moreover, combined training programs were the most effective for this population, in order to reduce the symptoms of the disease with a duration between 60 and 90 min, three times a week with a light to moderate intensity.
... Nine hundred forty-two were excluded for not being relevant and 416 did not meet the inclusion criteria. Ultimately, 68 studies were included in this systematic review with meta-analysis (Wigers et al., 1996;Mannerkorpi et al., 2000;Mannerkorpi et al., 2009;Gowans et al., 2001;King et al., 2002;Richards, 2002;Astin et al., 2003;Schachter et al., 2003;Cedraschi, 2004;Redondo et al., 2004;Sencan et al., 2004;Da Costa et al., 2005;Kingsley et al., 2005;Zijlstra, 2005;Gusi et al., 2006;Hammond and Freeman, 2006;Fontaine and Haaz, 2007;Munguía-Izquierdo and Legaz-Arrese, 2007;Rooks, 2007;Tomas-Carus et al., 2007;Tomas-Carus et al., 2009;Tomas-Carus et al., 2018;Tomas-Carus et al., 2021;Günendi et al., 2008;Carson et al., 2010;Fontaine et al., 2010;Sañudo Corrales et al., 2010;Arcos-Carmona et al., 2011;Núñez et al., 2011;Sañudo et al., 2011;Sañudo et al., 2015;Baptista et al., 2012;García-Martínez et al., 2012;Jones et al., 2012;Kayo et al., 2012;Castel et al., 2013;Chan et al., 2014;Chan et al., 2017;Clarke-Jenssen et al., 2014;Giannotti et al., 2014;Martín et al., 2014;Larsson et al., 2015;Latorre Román et al., 2015;Ericsson et al., 2016;Espí-López et al., 2016;Kurt, 2016;Maddali Bongi et al., 2016;Ekici et al., 2017;Windthorst et al., 2017;Assumpção et al., 2018;Kashikar-Zuck et al., 2018;Wong et al., 2018;Andrade et al., 2019;Silva et al., 2019;Atan and Karavelioğlu, 2020;Garrido-Ardila et al., 2020;Izquierdo-Alventosa et al., 2020;Izquierdo-Alventosa et al., 2020;Sauch Valmaña et al., 2020;Serrat et al., 2020;Serrat et al., 2021b;Serrat et al., 2021a;Serrat et al., 2022;Fonseca et al., 2021;Haugmark et al., 2021;Hernando-Garijo et al., 2021;Arroyo-Fernández et al., 2022;de Lorena et al., 2022). The literature searches and study selection process is shown in the PRISMA flowchart (Figure 1), which shows the number of excluded references together with the reasons. ...
... Twenty-four studies (Mannerkorpi et al., 2000;Mannerkorpi et al., 2009;Cedraschi, 2004;Redondo et al., 2004;Rooks, 2007;Tomas-Carus et al., 2007;Tomas-Carus et al., 2009;Tomas-Carus et al., 2021;Sañudo Corrales et al., 2010;Arcos-Carmona et al., 2011;Núñez et al., 2011;Sañudo et al., 2011;Baptista et al., 2012;García-Martínez et al., 2012;Maddali Bongi et al., 2016;Windthorst et al., 2017;Assumpção et al., 2018;Andrade et al., 2019;Silva et al., 2019;Atan and Karavelioğlu, 2020;Sauch Valmaña et al., 2020;Serrat et al., 2021b;Serrat et al., 2021a;Serrat et al., 2022) assessed the effect of PEBT on the physical dimension of QoL. The quality of evidence was high, and there was a medium-sized effect indicating the superiority of PEBT for improving the physical dimension of QoL compared to other interventions (SMD = 0.51; 95% CI 0.33-0.69; ...
... The effect of PEBT on the mental dimension of QoL was assessed in 20 studies (Mannerkorpi et al., 2000;Mannerkorpi et al., 2009;Redondo et al., 2004;Rooks, 2007;Tomas-Carus et al., 2007;Tomas-Carus et al., 2009;Tomas-Carus et al., 2021;Sañudo Corrales et al., 2010;Arcos-Carmona et al., 2011;Núñez et al., 2011;Sañudo et al., 2011;Baptista et al., 2012;García-Martínez et al., 2012;Maddali Bongi et al., 2016;Windthorst et al., 2017;Assumpção et al., 2018;Andrade et al., 2019;Silva et al., 2019;Atan and Karavelioğlu, 2020;Sauch Valmaña et al., 2020). The quality of evidence was high, and there was a medium-sized effect indicating the superiority of PEBT for improving mental QoL compared to the other interventions when assessed immediately after therapy (SMD = 0.48; 95% CI 0.29-0.67; ...
The aim of our meta-analysis was to compile the available evidence to evaluate the effect of physical exercise-based therapy (PEBT) on pain, impact of the disease, quality of life (QoL) and anxiety in patients with fibromyalgia syndrome (FMS), to determine the effect of different modes of physical exercise-based therapy, and the most effective dose of physical exercise-based therapy for improving each outcome. A systematic review and meta-analysis was carried out. The PubMed (MEDLINE), SCOPUS, Web of Science, CINAHL Complete and Physiotherapy Evidence Database (PEDro) databases were searched up to November 2022. Randomized controlled trials (RCTs) comparing the effects of physical exercise-based therapy and other treatments on pain, the impact of the disease, QoL and/or anxiety in patients with FMS were included. The standardized mean difference (SMD) and a 95% CI were estimated for all the outcome measures using random effect models. Three reviewers independently extracted data and assessed the risk of bias using the PEDro scale. Sixty-eight RCTs involving 5,474 participants were included. Selection, detection and performance biases were the most identified. In comparison to other therapies, at immediate assessment, physical exercise-based therapy was effective at improving pain [SMD-0.62 (95%CI, −0.78 to −0.46)], the impact of the disease [SMD-0.52 (95%CI, −0.67 to −0.36)], the physical [SMD 0.51 (95%CI, 0.33 to 0.69)] and mental dimensions of QoL [SMD 0.48 (95%CI, 0.29 to 0.67)], and the anxiety [SMD-0.36 (95%CI, −0.49 to −0.25)]. The most effective dose of physical exercise-based therapy for reducing pain was 21–40 sessions [SMD-0.83 (95%CI, 1.1–−0.56)], 3 sessions/week [SMD-0.82 (95%CI, −1.2–−0.48)] and 61–90 min per session [SMD-1.08 (95%CI, −1.55–−0.62)]. The effect of PEBT on pain reduction was maintained up to 12 weeks [SMD-0.74 (95%CI, −1.03–−0.45)]. Among patients with FMS, PEBT (including circuit-based exercises or exercise movement techniques) is effective at reducing pain, the impact of the disease and anxiety as well as increasing QoL.
Systematic Review Registration: PROSPERO https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021232013.
... The exercise time ranged from 9 to 54 min for HIIT and 15 to 60 min for MICT, only two studies [58,68] used energy expenditure formulating exercise time. A total of 19 studies [42,43,[46][47][48][50][51][52][53][54]56,57,[59][60][61][62]64,67,69] instructed participants to exercise 3 times/week, nine studies [41,45,49,55,58,63,65,66,68] instructed > 3 times/week, and only one study [44] instructed once per week. A total of 14 studies [41,46,[49][50][51]53,54,58,61,63,64,[67][68][69] had dropouts, of which four studies [49][50][51]64] had <85% attendance rate. ...
... A total of 19 studies [42,43,[46][47][48][50][51][52][53][54]56,57,[59][60][61][62]64,67,69] instructed participants to exercise 3 times/week, nine studies [41,45,49,55,58,63,65,66,68] instructed > 3 times/week, and only one study [44] instructed once per week. A total of 14 studies [41,46,[49][50][51]53,54,58,61,63,64,[67][68][69] had dropouts, of which four studies [49][50][51]64] had <85% attendance rate. ...
... A total of four studies [48,50,67,68] did not report sex ratio, the sex ratio of the remaining studies was 2:3. The participants in 20 included studies [44][45][46][47][48][49][51][52][53][54][55][57][58][59][60][61]63,66,68,69] were people with sedentary obesity, two studies [30,56] were sedentary only, and seven studies [41][42][43]50,62,64,67] were other medical comorbidities (two Type 1 diabetes, two Type 2 diabetes, one prediabetes, one polycystic ovary syndrome, and one fibromyalgia). ...
Objectives:
This systematic review is conducted to evaluate the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on body composition and cardiorespiratory fitness (CRF) in the young and middle-aged.
Methods:
Seven databases were searched from their inception to 22 October 2022 for studies (randomized controlled trials only) with HIIT and MICT intervention. Meta-analysis was carried out for within-group (pre-intervention vs. post-intervention) and between-group (HIIT vs. MICT) comparisons for change in body mass (BM), body mass index (BMI), waist circumference (WC), percent fat mass (PFM), fat mass (FM), fat-free mass (FFM), and CRF.
Results:
A total of 1738 studies were retrieved from the database, and 29 studies were included in the meta-analysis. Within-group analyses indicated that both HIIT and MICT can bring significant improvement in body composition and CRF, except for FFM. Between-group analyses found that compared to MICT, HIIT brings significant benefits to WC, PFM, and VO2peak.
Conclusions:
The effect of HIIT on fat loss and CRF in the young and middle-aged is similar to or better than MICT, which might be influenced by age (18-45 years), complications (obesity), duration (>6 weeks), frequency, and HIIT interval. Despite the clinical significance of the improvement being limited, HIIT appears to be more time-saving and enjoyable than MICT.
... The study strategy is shown in the form of a flow chart (Appendix A). From 429 studies initially detected, a total of eight studies were included, six randomized controlled trials [38][39][40][41][42][43][44] and one randomized cross-over trial [45]. Five were from Europe, [41][42][43][44][45] two from Oceania [39,40] and one from the Middle East [38]. ...
... From 429 studies initially detected, a total of eight studies were included, six randomized controlled trials [38][39][40][41][42][43][44] and one randomized cross-over trial [45]. Five were from Europe, [41][42][43][44][45] two from Oceania [39,40] and one from the Middle East [38]. A total of 380 participants with a mean age ranging from 30.2 to 62.4 years were included. ...
... A total of 380 participants with a mean age ranging from 30.2 to 62.4 years were included. The patients were mostly women (50-100%) diagnosed with fibromyalgia [38], persistent pain condition [39], knee osteoarthritis [40], rheumatoid arthritis [45], adults with juvenile idiopathic arthritis [45], axial spondyloarthritis [41,42], or psoriatic arthritis [43,44]. Details of the participant's characteristics and studies are shown in Appendix A. ...
In order to assess the impact of high-intensity interval training (HIIT) on biological and body composition variables in patients with musculoskeletal disorders (MSKD), a systematic search on PubMed (Medline), CENTRAL, CINAHL, Web of Science, SPORTDiscus, and Scopus was conducted. Standardized mean differences (SMD) and 95% confidence intervals were calculated and pooled in a meta-analysis using the random-effects model. The effectiveness of HIIT on waist circumference, muscle mass, resting heart rate, resting systolic and diastolic blood pressure, C-reactive protein, body weight, and body fat were determined. GRADE, risk of bias 2, and PEDro scales were employed. HIIT compared to no intervention, minimal intervention, or usual care did not show significant results in its favor on any of the variables studied, except for the resting heart rate when compared with no intervention (SMD = −0.33; 95% CI: −0.63, −0.04; heterogeneity Q value: 0.14; p = 0.93; I2 = 0%). In addition, HIIT also does not seem to be more effective than moderate-intensity continuous training. Based on the results, it seems that HIIT has almost no significant effects on biological and body composition variables, except for resting heart rate, in patients with MSKD.
... A particularly relevant aspect of subjective tinnitus is its modulability through the somatosensory system [31][32][33][34][35]. In about two-thirds of patients with subjective tinnitus, the perception of sound can be modified by muscle contractions or movements of the neck, head, or jaw [36][37][38][39]. This phenomenon, known as somatosensory tinnitus, suggests that the somatosensory system can influence tinnitus perception and implies that alterations in muscular or articular structures can impact its intensity and tone [40][41][42]. ...
... To investigate the correlation between TMD and otologic symptoms (OS). 36.18% (n = 89) had OS. ...
Background/Objectives: Tinnitus, often described as a ringing in the ears, affects a significant portion of the population, varying in perception and severity. Methods: This systematic review investigates the correlation between tinnitus and temporomandibular joint disorders (TMDs) within a PRISMA-compliant framework, ensuring methodological transparency and rigor. Using databases, such as PubMed, Scopus, and Web of Science, we analyzed studies from the past decade to evaluate clinical and observational evidence. Results: A significant association between TMD and tinnitus was found, with somatosensory and neuroplastic mechanisms contributing to this relationship. Key therapeutic approaches identified include manual therapy and multidisciplinary treatments, demonstrating potential clinical efficacy. Conclusions: However, the available evidence remains inconsistent, emphasizing the need for further research with standardized methodologies to improve understanding and refine therapeutic strategies. This review provides a foundation for future studies aiming to enhance tinnitus management by addressing underlying TMD-related mechanisms.
... Furthermore, exercise stimulates the production of endogenous opioids and β-endorphins, which activate descending nociceptive inhibitory mechanisms and result in hypoalgesia (Tan, et al., 2022). Additionally, we observed some research such as Atan T's study (Atan, et al., 2020) shows a high negative effect, demonstrated higher negative effects, SMD = −2.18 (95%CI −3.01, −1.34) in high-intensity interval training (HIIT) and [SMD = −1.76 ...
... outcome measures related to FMS. Similarly, Atan T's study revealed a favorable effect on mental health after completing five sessions per week for up to 6 weeks (Atan, et al., 2020). However, the Sanudo B's study implemented twice a week intervention for a duration of up to 6 months (Sañudo, et al., 2012), while the Hernando-Garijo I's study encompassed 30 sessions (Hernando-Garijo, et al., 2021) . ...
Background
The Fibromyalgia Syndrome (FMS) is a multifaceted chronic pain disorder that exerts a substantial impact on the overall state of health and quality of life of patients.
Purpose
Investigate the effects of exercise therapy and adherence to the American College of Sports Medicine (ACSM) guidelines on treatment outcomes in FMS patients.
Methods
The literature search, which concluded in October 2023, encompassed studies investigating the impact of exercise interventions on patients diagnosed with FMS and providing adequate data for calculating standardized mean difference (SMD). The primary outcome measures encompassed the Fibromyalgia Impact Questionnaire (FIQ) and Health Assessment Questionnaire (HAQ), while secondary outcome measures comprised pain levels, sleep quality, fatigue, and mental health.
Results
Among 4,008 records, 19 studies (patients = 857) were eligible for qualitative synthesis. The meta-analysis revealed that the SMD for overall state of health impact was −0.94 (95%CI −1.26, −0.63), and the pooled SMD for the subgroup with high adherence to ACSM guidelines was −1.17 (95%CI −1.65, −0.69). The SMD for the subgroup with low or uncertain adherence was −0.73 (95%CI −1.12, −0.34). The overall effects included a −1.21 (95%CI −1.62, −0.79) SMD for pain relief, with high adherence achieving a −1.32 (95%CI −2.00, −0.64) SMD and low adherence a −1.06 (95%CI −1.55, −0.57) SMD. Mental health improvements showed a −0.95 (95%CI −1.32, −0.57) overall SMD, with high and low adherence subgroups at −0.96 (95%CI −1.62, −0.30) and −0.94 (95%CI −1.29, −0.60), respectively. Sleep quality impact was −1.59 (95%CI −2.31, −0.87) overall, with high adherence at −1.71 (95%CI −2.58, −0.83) and low adherence at −1.11 (95%CI −1.88, −0.33). Fatigue impact had a −1.55 (95%CI −2.26, −0.85) overall SMD, with −1.77 (95%CI −3.18, −0.36) for high adherence and −1.35 (95%CI −2.03, −0.66) for low adherence.
Conclusion
Exercise therapy can improve the overall state of health, pain, sleep, and fatigue of FMS patients, particularly when adhering to ACSM guidelines. However, adherence levels do not affect mental health gains, indicating a need for future research on psychological impact.
Systematic Review Registration
https://inplasy.com/inplasy-2024-3-0106/, identifier INPLASY202430106.
... Recent studies demonstrate that HIIT has promising effects for a variety of chronic pain problems. Researchers have investigated that HIIT sessions at moderate to high intensity levels improved fibromyalgia patients' quality of life, functional ability, and pain reduction (Atan and Karavelioğlu, 2020;Botta et al., 2022). Similarly, a study found that Type 2 diabetesrelated neuropathic pain was reduced after HIIT sessions . ...
Abstract
Regular exercise produces a variety of physiological changes that improve exercise capacity and health, regardless of age, gender, or chronic illness status. Despite widespread physical inactivity due to time restrictions, High-Intensity Interval Training (HIIT) has evolved as a popular and time-saving strategy for strenuous exercise that improves physical fitness by increasing maximum oxygen uptake (VO2max) and muscle power. HIIT, which consists of brief bursts of intense activity at or near peak effort interspersed with intervals of rest or low-intensity exercise, causes a variety of physiological changes that improve exercise capacity and metabolic health in both clinical and healthy populations. Given the expanding scientific understanding and broad use of HIIT, this clinical commentary seeks to thoroughly investigate its definition, parameters, scientific foundations, multifarious benefits, and evidence acrossvaried groups and situations.
Keywords
High intensity interval training – scientific foundations – chronic health diseases – exercise – training
... Chronic musculoskeletal pain represents the leading cause of disability and is a major contributor to a reduced quality of life, affecting approximately 10% of the global popula- high-intensity interval training and mobility exercises, on somatosensory pain mechanisms in FM [29,30]. To date, no study has investigated the effects of a combined program incorporating high-intensity interval training, strength exercises, and mobility exercises on clinical outcomes in FM women. ...
(1) Background: Fibromyalgia syndrome (FM) is a specific condition within the spectrum of musculoskeletal pain disorders, with an estimated global prevalence of 2%. Physical exercise has shown promise in modulating pain and improving physical function without the drawbacks of pharmacotherapy. This study aims to examine the effects of a 6-week telerehabilitation combined exercise program—including mobility, strength, and high-intensity exercises—on pain, psychological variables, and disability in women with fibromyalgia. (2) Methods: In this observational study involving 53 FM patients, the outcomes measured were the pressure pain threshold (PPT), the conditioned pain modulation (CPM) paradigm, levels of pain on the measurement day and the average of the last week (using NRS) the impact of the fibromyalgia (using Fibromyalgia Impact Questionnaire (FIQ), and anxiety (using the Spanish version of the State–Trait Anxiety Inventory—STAI). (3) Results: Statistically significant changes were observed in the intervention group in PPT, CPM, NRS, and FIQ. (4) Conclusions: A six-week telerehabilitation therapeutic exercise intervention consisting of two scheduled exercise sessions per week lasting approximately 45 min each is associated with reduced pain levels, enhanced pain inhibitory pathways, and a decreased impact of fibromyalgia compared to patients who do not adopt a more active lifestyle.
... Fibromyalgia (FM) is classified as a chronic rheumatic disease and is characterized by chronic widespread pain, muscle stiffness, sleep disturbances and cognitive problems (Atan & Karavelioğ lu, 2020a;Chica et al., 2019;Norouzi et al., 2020;O'Dwyer et al., 2019). In addition to these, the following symptoms are also observed: a feeling of fatigue and changes in the psychological state (Chafer & Hamilton, 2015a). ...
Fibromyalgia is a chronic disease that affects patients’ quality of life, leading to reduced physical activity levels. This problem
can therefore be attenuated by promoting physical exercise training programs (PETP). The aim of this pilot study was to develop and validate a PETP, “Pessoas com Fibra”, designed to increase physical activity and improve the quality of life of women diagnosed with Fibromyalgia, aged between 30 and 60. The PETP was designed and validated by physical fitness specialists in accordance with Revised Guidelines for Reporting Criteria on the Development and Evaluation of Complex Health Interventions and the Consensus Guidelines on Physical Exercise Programme Reporting Model. It went through three phases: development, piloting and evaluation. This study presents an intervention proposal based on improving the participants' Fibromyalgia symptoms. “Pessoas com Fibra” program proposal presents suggestions for adaptation to the target population and exercises that can be replicated by professionals in the field of physical
exercise and health.
... Regardless of the diagnosis (depression or FM), the regular practice of PE is recommended as an alternative treatment for both groups of patients (Schuch et al., 2016;Sieczkowska et al., 2020b). Given this, several studies have analyzed different modalities of PE (Gavi et al., 2014;Macfarlane et al., 2017;Atan and Karavelioğlu, 2020), among which RT has shown positive results in improving depression in patients with FM (Andrade et al., 2017(Andrade et al., , 2018aVilarino et al., 2021). ...
Background
Fibromyalgia (FM) is characterized by widespread chronic pain. Although pain is the main symptom, approximately 90% of patients have depression. This study aimed to analyze the effects of Resistance Training (RT) with low and high intensity on depression in patients with FM.
Methods
Thirty-eight women with FM and 31 healthy women were allocated to the low-intensity, high-intensity, preferred-intensity, and control groups. The patients underwent 8 weeks of supervised RT, with two sessions per week of approximately 1 h. The low-intensity resistance training group (LIRT) performed two sets of 12 maximum repetitions. The high-intensity resistance training group (HIRT) performed four sets with six maximum repetitions, and the preferred intensity group (PI) performed three sets, with eight to 12 repetitions, according to the patient’s tolerance. The healthy control group did not perform any type of exercise. Depression was assessed using the Beck depression inventory before the start of the intervention, after 4 and 8 weeks.
Results
FM patients have higher levels of depression than women without the disease. After 4 weeks, there was a difference in depressive symptoms between the HIRT and LIRT (p = 0.048), and the PI and LIRT (p = 0.048).
Conclusion
Prescribing RT with low or high intensity did not significantly reduce depression in patients with FM after 8 weeks, however, analyses between groups after 4 weeks indicated that low-intensity training is more effective than high-intensity training. The prescription of RT exercise to FM could vary among low, high, and preferred intensity, following the patient’s tolerance for pain.
Clinical trial registration
https://ensaiosclinicos.gov.br/rg/RBR-74pcmw, RBR-74pcmw.
... Additionally, the use of mobile devices and applications allows patients to enhance selfengagement, monitor symptoms, and understand their condition better, which directly translates to improved physician-patient collaboration and achieving optimal therapeutic outcomes. However, it should be noted that despite the promising results of new therapies, they do not provide better long-term outcomes than the non-pharmacological therapies present in current guidelines [72]. Nevertheless, they may impact other aspects of patient well-being, leading to an improved quality of life. ...
Introduction and purpose Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairment, affecting 2-4% of the global population, with a higher prevalence among women and those of lower socioeconomic status. The pathogenesis of FM is complex and multifactorial, involving central sensitization and neurochemical dysregulation. This review highlights the latest advancements in pharmacological and behavioral therapies for fibromyalgia. State of knowledge Management of fibromyalgia currently is based on a combination of medication use and non-pharmacological approaches, primarily based on physical activity and cognitive-behavioral therapy. This review explores advancements in FM treatments, focusing on novel pharmacological agents such as vortioxetine, eslicarbazepine acetate, and tapentadol, which target specific neurochemical pathways to alleviate symptoms. Vortioxetine offers new mechanisms of action with potential cognitive benefits, while eslicarbazepine acetate and tapentadol provide alternative approaches for pain modulation and central sensitization. Additionally, non-pharmacological therapies, including high-intensity interval training (HIIT) and virtual reality (VR) therapy, demonstrate promise in enhancing physical fitness, reducing pain, and improving quality of life for FM patients. Summary Overall, the integration of these novel therapies into comprehensive, individualized treatment plans can optimize outcomes and enhance the quality of life for individuals with FM. Ongoing research and personalized medicine approaches are essential to further refine and validate these emerging treatments.
... This outcome could be related to the ventilatory control and perception of dyspnea. Patients with fibromyalgia may exhibit altered respiratory control patterns or heightened sensitivity to dyspnea, resulting in lower RF during aerobic exercise [40]. In this sense, differences in ventilatory control mechanisms and perception of dyspnea (i.e., shortness of breath) might contribute to variations in RF between patients with FM and OCP disorders. ...
Understanding the differences in ventilatory responses during exercise between patients with fibromyalgia and those with other chronic pain disorders is crucial for developing effective therapeutic interventions, especially in exercise to identify the better physical therapy prescription. Both populations face unique challenges that impact their ability to engage in physical activity; yet, the underlying physiological responses can vary significantly. In this context, the methodology of this study entailed conducting a comparative analysis of the ventilatory response during exercise in patients with fibromyalgia and those with other chronic pain disorders. The experimental protocol included a total of 31 participants (n = 13 diagnosed with fibromyalgia and n = 18 diagnosed with other chronic pain conditions). All participants completed a stress test, where the ventilatory parameters were measured in three stages (i.e., resting, incremental exercise, and recovery). The results revealed significant differences (p<0.05) in ventilatory responses between both groups. Patients with fibromyalgia exhibited reduced time for the aerobic threshold and a higher respiratory frequency in the anaerobic threshold compared to those with other chronic pain disorders. Furthermore, fibromyalgia patients demonstrated higher values in the ventilatory coefficient during the test and in the recovery stage. In conclusion, these differences underscore the need for tailored exercise programs that specifically address the unique ventilatory challenges faced by fibromyalgia patients to improve their physical function and overall quality of life.
... In 3 studies, aerobic exercise varied between aquatic training, high-intensity training, and high-intensity Nordic walking. [22][23][24] Muscle strength training varies between resistance training with low loads or high loads in 2 studies 25,26 and mat Pilates in 1 study. 27 The flexibility exercises are based on stretching exercises in 1 study. ...
Background: To identify in the literature the exercise training therapies for females with fibromyalgia that may improve pain management and quality of life (QOL).
Methods: A literature search was conducted in MEDLINE and PEDro databases for human studies up to June 2021. We considered studies if they investigated exercise therapies and their impact on pain, QOL, physical function, and mental health in female patients with fibromyalgia.
Results: We identified 112 clinical trials. After posterior analyses, 15 articles were selected, and 8 were considered eligible.
Conclusions: Selected studies demonstrated that highintensity and moderate-intensity aerobic training combined or not with muscle strength anaerobic exercise reduces pain and improves QOL in females with fibromyalgia.
Key words: exercise, fibromyalgia, pain, quality of life
... We did indeed find publication bias for the physical QoL domain which should be appropriately considered in the interpretation of these results. Furthermore, some studies (Madssen et al. 2014;Malmo et al. 2016;Ellingsen et al. 2017;Mokhtarzade et al. 2017;Romain et al. 2019;Atan and Karavelioğlu 2020;Burn et al. 2021;Mueller et al. 2021;Ochi et al. 2022;Woodfield et al. 2022) measured QoL as a secondary outcome so may not have been appropriately powered. ...
Aim
This study aimed to ascertain the impact of high intensity interval training (HIIT) on physical, mental, and overall quality of life (QoL) through a comprehensive systematic review and meta-analysis.
Subject and methods
A systematic search for relevant trials was performed via PubMed, the Cochrane Library and Web of science as well as the manual screening of prior meta-analyses and their respective reference lists (PROSPERO reference: CRD42022326576). Adult controlled trials investigating the effects of a >2-week HIIT intervention with an eligible non-intervention control group were considered. As the primary outcome, studies were required to include at least one measure of physical and/or mental and/or overall QoL, on any validated QoL domain, pre and post intervention.
Results
Twenty-two studies with twenty-four effect sizes were included; seventeen comparing HIIT and overall QoL, fourteen comparing HIIT and physical QoL and thirteen studies comparing HIIT and mental QoL. There was a statistically significant improvement in physical (SMD= 0.405, 95% CI: 0.110- 0.700, p= 0.007), mental (SMD= 0.473, 95% CI: 0.043 –0.902, p=0.031) and overall QoL (SMD= 0.554, 95% CI 0.210-0.898, p=0.002) following a program of HIIT. Secondary analysis of 5 studies comparing HIIT against moderate intensity continuous training demonstrated no significant difference in improvement between the two modes (SMD= -0.094, CI= -0.506-0.318, p=0.655).
Conclusion
Engaging in HIIT produces statistically significant improvements in physical, mental, and overall quality of life in clinical and non-clinical populations at a small to moderate effect size. Furthermore, HIIT appears as effective as MICT in improving overall QoL, offering a more time-efficient exercise option.
... In 3 studies, aerobic exercise varied between aquatic training, high-intensity training, and high-intensity Nordic walking. [22][23][24] Muscle strength training varies between resistance training with low loads or high loads in 2 studies 25,26 and mat Pilates in 1 study. 27 The flexibility exercises are based on stretching exercises in 1 study. ...
Background
The purpose of this study is to examine the evidence of the effectiveness of telemedicine in postural stability treatment in independent patients affected by Parkinson's disease (PD).
Methods
This is a literature review of studies investigating the effect of telemedicine in postural stability treatment in independent patients affected by PD. PRISMA guidelines were followed during the design, search, and reporting stages of this review. The search was carried out in the MEDLINE databases.
Results
A total of 1854 studies were detected and analyzed by performing the proposed searches in the detailed databases. After removing duplicates and analyzing the titles and abstracts of the remaining articles, 6 studies were ultimately selected for this review. At least 50% of the studies included in this review showed positive results in improving postural stability in patients with PD after a home-based intervention.
Conclusions
The home-based intervention based upon technologically assisted telerehabilitation may support the aspects of an effective and efficient physical therapy allowing the physiotherapists to deliver functional rehabilitation in the home setting outside the hospital and supervise more than one patient simultaneously during rehabilitation sessions.
... In regard to the level of physical activity, there is no consensus or certainty about what type of exercise is the most optimal for health and the reduction in symptoms in patients with fibromyalgia (FM), both in the short term and especially in the long term [26]. Currently, low and medium intensity exercise seems to improve the quality of life in patients with FM [27], however, some authors consider high intensity exercise to be just as beneficial for their health [28]. With regards to pain, strength exercise may be the most indicated, while aerobic exercise would improve quality of life. ...
Nowadays, there is evidence that relates the amount of physical activity, as well as the impact of psychological factors, to the intensity of symptoms present in patients with fibromyalgia (FM). However, there are no studies which correlate the level of association of physical activity, psychological factors and vegetative symptoms in the FM population. The study has a cross-sectional observational design with 41 participants being recruited from a private clinic and rehabilitation service. The Autonomic Symptom Profile (Compass-31) to assess vegetative symptoms, the GODIN questionnaire to evaluate the level of leisure activity, and the pain catastrophizing scale, Tampa Kinesiophobia Scale and Self-Efficacy Scale to assess psychological factors, were used. A low and significant level of association was found between pain catastrophizing (PCS) and Kinesiophobia (r = 0.398; p < 0.01), as well as with catastrophizing and vegetative symptoms (r = 0.428; p < 0.05). Furthermore, a low and significant level of association was also found between self-efficacy and vegetative symptoms (r = 0.397; p < 0.05). No association was found between the level of daily physical activity (measured by the Godin Leisure questionnaire) and vegetative symptoms, nor with any psychological factor studied. There is an association between vegetative symptoms and psychological factors. Nevertheless, more research which takes other factors into account, such as lifestyle and nutritional, is needed.
... 19 This will help prevent shortfalls such as the ones observed in several "pilot" studies, which concluded that there is a need to study feasibility (e.g., adherence, "usefulness" to a group with more advanced disease) in the future. 34,35 Authors of one study mentioned that they carried out a previous evaluation of the study protocol to confirm acceptability and safety (although this was not published). 24 Similar practices may be helpful to researchers for planning in the form of an initial acceptability or needs assessment survey, for example. ...
Pilot and feasibility studies are conducted early in the clinical research pathway to evaluate whether a future, definitive study can or should be done, and if so, how. Poor planning and reporting of pilot and feasibility studies can compromise subsequent research efforts. Inappropriate labelling of studies as pilots also compromises education. In this review, first a systematic survey of the current state of pilot and feasibility studies in rehabilitation research was performed, and second, recommendations were made for improvements to their design and reporting. In a random sample of 100 studies, half (49.5%) were randomized trials. Thirty (30.0%) and three (3.0%) studies used 'pilot' and 'feasibility' in the study title, respectively. Only one third (34.0%) of studies provided a primary objective related to feasibility. Most (92.0%) studies stated an intent for hypothesis testing. Although many (70.0%) studies mentioned outcomes related to feasibility in the methods, a third (30.0%) reported additional outcomes in the results and discussion only, or commented on feasibility anecdotally. The reporting of progression plans to a main study (21.0%) and progression criteria (4.0%) was infrequent. Based on these findings, it is recommended that researchers correctly label studies as a pilot or feasibility design based on accepted definitions, explicitly state feasibility objectives, outcomes and criteria for determining success of feasibility, justify the sample size, and appropriately interpret and report the implications of feasibility findings for the main future study.
... This is also evident by the improvements (50%) in pain perception as this was assessed by the FIQ tool. Simiral changes have been observed in other patients' populations including fibromyalgia patients [54,55] where changes in QoL and exercise capacity were followed by improvements in pain score. ...
Purpose
Hemodialysis (HD) patients suffer from generalized weakness, exercise intolerance and muscle atrophy, all leading to generalized fatigue and lack of energy. HD patients spend at least 50% of their time in a functionally “switch off” mode with their fatigue sensations reaching a peak in the immediate hours after the dialysis session. The purpose of the current study was to assess the effectiveness of a nine-month hybrid intradialytic exercise program on fatigue symptoms occurring during and after hemodialysis session.
Methods
Twenty stable hemodialysis patients were included in the study (59 ± 13.7 years; 16 males). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training during HD. Aspects related to physical and generalized fatigue were assessed via validated questionnaires, while physical performance was assessed by a battery of tests, before and after the intervention period.
Results
Exercise capacity and physical performance were increased by an average of 65 and 40%, respectively. Patients reported feeling better during post-dialysis hours in question 1 (p = 0.000), question 3 (p = 0.009) and question 4 (p = 0.003) after the 9-month intervention. In addition, exercise training improved scores in cognitive function (p = 0.037), vitality (p = 0.05), depression (p = 0.000) and fatigue (p = 0.039).
Conclusion
The present study showed that a 9-month hybrid (aerobic + resistance) exercise training program improved symptoms of post-dialysis fatigue and overall general perception of fatigue. Hybrid exercise training is a safe and effective non-pharmacological approach to ameliorate fatigue symptoms in HD patients.
Trial registration number
Trial registration number The study is registered at ClinicalTrials.gov (NCT01721551, 2012) as a clinical trial.
Background
Therapeutic exercise (TE) is the only intervention with strong recommendation for fibromyalgia. However, there is controversy as to which type of exercise is the most beneficial.
Objective
To determine which TE approach is the most effective in reducing pain intensity in women with fibromyalgia.
Methods
A systematic review was performed with a network meta-analysis (NMA). Six databases were searched from inception until January 2024. Randomized controlled trials (RCTs) evaluating the effects of TE on pain intensity were included in women with fibromyalgia. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The size of the effect and the clinically important difference were determined in the short-term (≤3 months) and long-term (>3 months).
Results
Sixty-one studies were identified, of which 51 were included in the quantitative synthesis (n = 2873). Fifteen TE interventions and eight comparison interventions (comparators) were identified. Aquatic exercise (p-score: 0.8713) was found to provide best benefits in the short-term and resistance training in the long-term (p-score: 0.9749). Statistically significant differences were found in favor of aquatic exercise, Pilates, qigong, resistance training, virtual reality, mixed exercise, and aerobic exercise (in the short-term) and in favor of resistance training, dance, functional training, aquatic exercise, virtual reality, and aerobic exercise (in the long-term) compared to usual care.
Conclusion
With a moderate level of evidence, our NMA shows that, in the short-term, aquatic exercise is the most effective TE intervention to reduce pain intensity in women with fibromyalgia, while resistance training is the most effective in the long-term. More RCTs are needed to strengthen these findings.
Introdução: A fibromialgia trata-se de uma síndrome dolorosa crônica de etiologia complexa com significativo impacto na funcionalidade e qualidade de vida dos pacientes. A atividade física é recomendada como tratamento não farmacológico de primeira linha, com potenciais benefícios fisiológicos e psicossociais. No entanto, sua adesão na prática clínica ainda é limitada. Objetivo: Analisar a eficácia comparativa de diferentes modalidades de exercício físico na redução da dor, melhora da função motora e qualidade de vida em pacientes com fibromialgia. Metodologia: Trata-se de revisão sistemática desenvolvida em consonância com a Declaração dos Principais Itens para Relatar Revisões Sistemáticas e Meta-análises (PRISMA), utilizando as bases de dados Embase, MEDLINE, PubMed e ScienceDirect. Resultados e Discussão: Exercícios aquáticos demonstraram maior eficácia na redução da dor e melhoria do sono, enquanto exercícios terrestres foram mais eficazes na força muscular. Intervenções multicomponentes (atividade física combinada a educação em dor e suporte psicológico) foram as mais eficazes. A individualização dos programas e o contexto de aplicação (ambiente clínico, domiciliar ou atenção primária) influenciaram diretamente a adesão e os resultados. A inclusão de estratégias como Terapia Cognitivo-Comportamental, mindfulness e educação em neurofisiologia da dor potencializou os benefícios das intervenções físicas. Conclusão: A atividade física, especialmente em programas multicomponentes e individualizados, é uma estratégia eficaz para o manejo da fibromialgia.
A síndrome da fibromialgia (SFM) é uma condição caracterizada por dor crônica generalizada, juntamente com fadiga e distúrbios do sono. A etiologia e fisiopatologia da SFM permanecem obscuras; no entanto, a literatura atual apoia a hipótese de envolvimento de sensibilização central, pela qual os sinais de dor e as sensações subsequentes são amplificadas nas vias do sistema nervoso central. A incidência é maior em mulheres. Nesses termos, o presente artigo buscou responder a seguinte pergunta-guia: de que forma a prática de atividade física é eficaz no tratamento da síndrome da fibromialgia, especialmente em mulheres? Trata-se de uma revisão sistemática que perpassou pela realização de buscas até setembro de 2023 na plataforma de dados PubMed utilizando os seguintes descritores: Fibromyalgia; Exercise; Women. Foram incluídos trabalhos que avaliaram a relação entre a prática de atividades físicas e o tratamento da fibromialgia, principalmente em mulheres. Foram descartadas publicações que abordavam exercícios físicos relacionados a outros contextos de enfermidades. Ao fim, foram selecionados 5 trabalhos. Os achados sugerem que, embora o exercício físico não seja a cura definitiva para a fibromialgia, os estudos sugerem que ele desempenha um papel importante no manejo da síndrome.
Background
Exercise intensity is a key component of an exercise prescription. This meta‐analysis aimed to investigate the treatment effect of different exercise doses on fibromyalgia syndrome.
Methods
PubMed, Embase, Web of Science, and the Cochrane Library were searched from their inception until 29 December 2023. The studies were subjected to screening using a 2‐phase approach by 2 independent reviewers. Reference lists of the included studies were manually searched. Two independent reviewers extracted information regarding the origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures, and main results using a pre‐defined template.
Results
This meta‐analysis encompassed a total of 19 randomized controlled trials comprising 857 patients. Compared with the low compliance/uncertain group according to ACSM, the high compliance group showed better effectiveness in general condition improvement (SMD: −1.15 > −0.71), pain relief (SMD: −1.29 > −1.04), sleep quality enhancement (SMD: −1.66 > −1.08), and fatigue relief (SMD: −1.72 > −1.32). However, there was no difference in the improvement of mental health between the two groups (SMD: −0.93 > −0.92).
Conclusion
Compared to the ACSM group with compliance uncertainty (<70%), the high compliance group showed improvement in general conditions, pain, sleep quality, and fatigue. However, there was no difference in terms of mental health.
Fibromyalgia and a chronic rheumatic syndrome is joint pain for three months (tender points) and which affects different parts of various types of pain (lasting three months or more). The study aims to address the beneficial effects of physical exercise in diagnosed people. This is bibliographic research with a qualitative approach. Observing physical exercise for the evolution of effects that significantly contributes to the significant reduction of fibromyalgia, increased sleep quality, improved fatigue, increased disorders and functional capacity associated with muscle strength, muscle endurance, cardiovascular and respiratory condition and flexibility. It is concluded that the treatment of physical exercise guidance can promote beneficial effects of physical education through a treatment of beneficial physical exercises through a beneficial treatment for daily practice.
Background
To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT).
Methods
Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis.
Results
One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge’s g = 0.015 (95%CI: − 0.088–0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge’s g = − 0.313 (95%CI: − 0.681–0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence.
Conclusions
Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints.
Registration
This review was registered in the PROSPERO database and given the identifier CRD42019103313.
Background
Exercise is one of the most recommended management strategies by treatment guidelines for fibromyalgia (FM); however, the mechanism through which exercise improves pain in FM is still unknown.
Objective
We aimed to summarize the hypothesized theoretical mechanisms for the pain-relieving effects of exercise in people with FM.
Eligibility Criteria
Randomized controlled trials (RCTs) in English reporting mechanisms for pain-relieving effects of exercise in the ‘Introduction’ and ‘Discussion’ sections and significant within- group or between-group effects of exercise interventions were included.
Sources of Evidence
We searched the databases Ovid MEDLINE(R), EMBASE, CINAHL, COCHRANE, Sports Discuss, and AMED with the keywords: exercise and fibromyalgia until December 2021.
Charting Methods
Two authors independently performed title/abstract, full-text review, and data abstraction using a data abstraction form. The hypothesized mechanisms from individual studies were grouped into three categories.
Results
The literature search resulted in 2147 studies, out of which 220 studies were considered for full-text review. A total of 50 RCTs proposing 29 unique mechanisms for the pain-relieving effects of exercise were included. These mechanisms were divided into three categories: physical, neuro-physiological, and psychological. The neuro-physiological category was further subdivided into exercise-induced hypoalgesia (EIH), pain sensitization, the autonomic system, the immune system, the endocrine system, and miscellaneous categories. The most frequently hypothesized mechanisms were EIH ( n = 15), autonomic modulation ( n = 7), improved sleep ( n = 6), muscle oxygenation ( n = 6), self-efficacy ( n = 5), mental health ( n = 4), and benefits of the aquatic environment ( n = 12). While all exercise interventions involved FM patients, most of the supporting evidence for these mechanisms was cited from previous studies conducted on healthy samples. No studies performed analyses to demonstrate causal associations between the mechanisms and outcomes.
Conclusion
Multiple mechanisms were hypothesized for the positive influence of exercise in people with FM. Future studies using causal analyses, such as mediation analysis, are recommended to validate these mechanisms.
Objective:
To meta-analyse the prevalence and predictors of dropout rates among adults with fibromyalgia participating in exercise randomized controlled trials (RCTs).
Data sources:
Two authors searched Embase, CINAHL, PsycARTICLES, and Medline up to 01/21/2023.
Study selection:
We included RCTs of exercise interventions in people with fibromyalgia that reported dropout rates.
Data extraction:
Dropout rates from exercise and control conditions and exerciser/participant, provider, and design/implementation related predictors.
Data synthesis:
A random effects meta-analysis and meta-regression were conducted. In total 89 RCTs involving 122 exercise arms in 3.702 people with fibromyalgia were included. The trim-and-fill-adjusted prevalence of dropout across all RCTs was 19.2% (95%CI=16.9%-21.8%), which is comparable to the dropout observed in control conditions with the trim-and-fill-adjusted odds ratio being 0.31 (95%CI = 0.92 to 1.86, P=0.44). Body mass index (R²=0.16, P=0.03) and higher impact of illness (R²=0.20, P=0.02) predicted higher dropout. The lowest dropout was observed in exergaming, compared to other exercise types (P=0.014), and in lower-intensity exercises, compared with high intensity exercise (P=0.03). No differences in dropout were observed for the frequency or duration of the exercise intervention. Continuous supervision by an exercise expert (e.g., physiotherapist) resulted in the lowest dropout rates (P<0.001).
Conclusions:
Exercise dropout in RCTs is comparable to control conditions, suggesting that exercise is a feasible and accepted treatment modality; however, interventions are ideally supervised by an expert (e.g., physiotherapist) to minimize the risk of dropout. Experts should consider a high BMI and the impact of the illness as risk factors for dropout.
Background
High-intensity interval training (HIIT) remains a promising exercise mode in managing cardiometabolic health. Large-scale analyses are necessary to understand its magnitude of effect on important cardiometabolic risk factors and inform guideline recommendations.
Objective
We aimed to perform a novel large-scale meta-analysis on the effects of HIIT on cardiometabolic health in the general population.
Methods
PubMed (MEDLINE), the Cochrane library and Web of Science were systematically searched. Randomised controlled trials (RCTs) published between 1990 and March 2023 were eligible. Research trials reporting the effects of a HIIT intervention on at least one cardiometabolic health parameter with a non-intervention control group were considered.
Results
This meta-analysis included 97 RCTs with a pooled sample size of 3399 participants. HIIT produced significant improvements in 14 clinically relevant cardiometabolic health parameters, including peak aerobic capacity (VO2) [weighted mean difference (WMD): 3.895 ml min⁻¹ kg⁻¹, P < 0.001), left ventricular ejection fraction (WMD: 3.505%, P < 0.001), systolic (WMD: − 3.203 mmHg, P < 0.001) and diastolic (WMD: − 2.409 mmHg, P < 0.001) blood pressure, resting heart rate (WMD: − 3.902 bpm, P < 0.001) and stroke volume (WMD: 9.516 mL, P < 0.001). Body composition also significantly improved through reductions in body mass index (WMD: − 0.565 kg m⁻², P < 0.001), waist circumference (WMD: − 2.843 cm, P < 0.001) and percentage body fat (WMD: − 0.972%, P < 0.001). Furthermore, there were significant reductions in fasting insulin (WMD: − 13.684 pmol L⁻¹, P = 0.004), high-sensitivity C-reactive protein (WMD: − 0.445 mg dL⁻¹, P = 0.043), triglycerides (WMD: − 0.090 mmol L⁻¹, P = 0.011) and low-density lipoprotein (WMD: − 0.063 mmol L⁻¹, P = 0.050), concurrent to a significant increase in high-density lipoprotein (WMD: 0.036 mmol L⁻¹, P = 0.046).
Conclusion
These results provide further support for HIIT in the clinical management of important cardiometabolic health risk factors, which may have implications for physical activity guideline recommendations.
Traditional continuous training and high-intensity interval training (HIIT) can increase maximal oxygen uptake (V̇O2max). However, there is conflicting evidence regarding which form of training demonstrates the greatest improvements to V̇O2max, and data in women is sparse. We conducted a systematic review and meta-analyses to assess whether moderate to vigorous-intensity continuous training (MVICT) or HIIT was superior at improving V̇O2max in women. Randomised controlled and parallel studies examined the influence of MVICT and/or HIIT on V̇O2max in women. There was no statistical difference in V̇O2max improvements after training between women in the MVICT and HIIT cohorts (mean difference [MD]: −0.42, 95%CI: −1.43 to 0.60, p>0.05). Both MVICT and HIIT increased V̇O2max from baseline (MD: 3.20, 95% CI: 2.73 to 3.67 and MD: 3.16, 95% CI 2.09 to 4.24, respectively, p<0.001). Greater improvements in V̇O2max were observed in women who participated in more training sessions in both training formats. Long-HIIT was superior to short-HIIT protocols at increasing V̇O2max. Although MVICT and long-HIIT sessions elicited greater increases in V̇O2max in younger women compared to short-HIIT protocols, these differences were negligible in older women. Our findings suggest MVICT and HIIT are equally effective strategies for improving V̇O2max and indicate an effect of age on its response to training in women.
The aim was to assess the impact of high-intensity interval training (HIIT) on patients with musculoskeletal disorders. We conducted a search of Medline, Embase, PEDro, and Google Scholar. We conducted a meta-analysis to determine the effectiveness of HIIT on pain intensity, maximal oxygen consumption (VO2 max), disability, and quality of life (QoL). We employed the GRADE and PEDro scales to rate the quality, certainty, and applicability of the evidence. Results showed significant differences in pain intensity, with a moderate clinical-effect (SMD = −0.73; 95% CI: −1.40–−0.06), and in VO2 max, with a moderate clinical-effect (SMD = 0.69; 95% CI: 0.42–0.97). However, the meta-analysis showed no statistically significant results for disability (SMD = −0.34; 95% CI: −0.92–0.24) and QoL (SMD = 0.40; 95% CI: −0.80–1.60). We compared HIIT against other exercise models for reducing pain intensity and increasing VO2 max. The meta-analysis showed no significant differences in favour of HIIT. Meta-regression analysis revealed that pain intensity scores were negatively associated with VO2 max (R² = 82.99%, p = 0.003). There is low-moderate evidence that the HIIT intervention for patients with musculoskeletal disorders can reduce pain intensity and increase VO2 max but has no effect on disability and QoL. Results also showed that HIIT was not superior to other exercise models in reducing pain intensity and increasing VO2 max.
Purpose: Patient-Reported Outcomes (PROs) and its measures (PROMs) are key to outcome assessment in Fibromyalgia (FM) trials. The aim of this review was to investigate which domains and instruments were assessed in recent FM trials and to compare them to recommendations by the Outcome Measures in Rheumatology (OMERACT) initiative. In addition, we investigated the overlap with a generic health assessment approach, i.e. eight domains suggested by the Patient-Reported Outcome Measurement Information System® (PROMIS®).
Methods: In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines , a systematic literature search in scientific databases including PubMed, PsycInfo, and Embase was conducted to identify studies that assessed at least two dimensions of health-related quality of life (HRQoL) from 2015 to June 2022. Non-rand-omized and randomized controlled trials were included in the analysis. We extracted PROs and PROMs used in each study.
Results: From 1845 identified records, 107 records out of 105 studies met the inclusion criteria. Studies investigated 50 PROs using 126 different PROMs. Most frequently assessed domains were pain, depression, fatigue, and anxiety (> 95% of the studies). The disease-specific FIQ was the most frequently applied PROM (82%). Overall, only 9% of the studies covered all domains deemed mandatory by OMERACT. Very few studies covered all eight generic health domains suggested by PROMIS.
Conclusion: The majority of trials covered most OMERACT domains or generic PROMIS health domains. There was, however, great variability in the instruments used to assess the domains, which points at a limited degree of standardization in the field.
Chronic pain is defined as pain that persists past the normal healing time. Physical activity and exercise programs are increasingly being promoted and used for a variety of chronic pain conditions. Evidence suggests that physical exercise is an intervention with few adverse events that may improve pain severity and physical function, thus improving the quality of life. High-intensity interval training (HIIT) has been shown to improve physical outcome measures and to decrease disorder related disability in people with chronic disorders. Since an overview of the benefits of HIIT on chronic pain conditions has not been published yet, this review aims to report the effects of HIIT alone or in combination with other forms of training on different kind of chronic pain conditions. A search in the main scientific electronic databases was performed. The results of the studies included in this review showed that HIIT is beneficial for several chronic pain conditions, improving pain and physical function. Since HIIT could represent a valid help to conventional drug therapies, it could improve the quality of life of these subjects. The actual quality of evidence remains very low, and further high evidence studies are needed to confirm the promising outcomes reported in this review.
Primary hypertension (HTN) and obesity are associated with a worse health-related quality of life (QoL). This research was carried out to analyze the health-related QoL measurements in a physically inactive and obese population with HTN (n = 253) in comparison to a HEALTHY sample (n = 30), to determine the HTN sample changes in QoL following different (high-volume moderate-intensity continuous training, high-volume high-intensity interval training (HIIT), low-volume HIIT) 16-week supervised aerobic exercise training (ExT) programs compared to attention control, and to assess the differences in QoL variables between the different ExT programs. The SF-36 questionnaire was used to assess health-related QoL. At baseline, HTN showed lower scores (p < 0.05) in physical function (88.6 vs. 99.2), general health (63.3 vs. 82.4), vitality (58.2 vs. 68.7), social functioning (88.5 vs. 95.2), and mental health (76.1 vs. 81.8) compared to HEALTHY. Following intervention, all HTN subgroups showed higher (p < 0.05) vitality, but physical functioning and general health significantly improved only in the ExT groups, with even better values in general health for both HIIT subgroups. Only the low-volume HIIT showed positive changes (p < 0.05) in social functioning (∆ = 6.9%) and mental health (∆ = 6.4%) domains after the intervention. These results highlight the important role of supervised exercise in improving physical and psychological health.
Background:
Both high-intensity interval training and moderate-intensity continuous training demonstrate beneficial physiological outcomes for active and insufficiently active populations. However, it remains unclear whether compliance to exercise in supervised settings translates to long-term adherence to physical activity in real-world, unstructured environments. To our knowledge, no comprehensive review is available on compliance and/or adherence rates to either modes of exercise for insufficiently active individuals. Furthermore, it is unclear which training modality insufficiently active individuals comply and/or adhere more readily to. Based on these gaps, the following two questions will be addressed: (1) What are compliance and adherence rates to high-intensity interval training for insufficiently active adults aged 18-65 years and (2) How do compliance and adherence rates differ between high-intensity interval training and moderate-intensity continuous training?
Methods:
Both observational and experimental studies that report on compliance and/or adherence rates to high-intensity interval training will be included. Relevant studies will be retrieved from Medline, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science using a pre-specified search strategy. Pre-defined inclusion and exclusion criteria will be used by two independent researchers to determine eligible studies. Of those meeting the inclusion criteria, data extraction and narrative synthesis will be completed, and where applicable, random-effects meta-analyses will be computed to compare compliance and adherence rates between high-intensity interval training and moderate-intensity continuous training. Meta-regressions and sensitivity analyses will be used to further explore factors that could influence aggregate effect sizes. Risk of bias will be assessed using established tools by the Cochrane association, and quality assessment of the cumulative evidence will be assessed using the GRADE approach.
Discussion:
Results from this study may have the potential to inform future physical activity recommendations and guidelines on the ideal mode of exercise for the general population. This review will add to the body of literature on the feasibility of high-intensity interval training for an insufficiently active population, conclusively addressing the ongoing debate of whether it is an appropriate exercise choice for this demographic. With this new information, individuals working towards a healthier lifestyle through physical activity engagement may be better equipped to make an evidence-based decision.
Systematic review registration:
This review has been registered in the PROSPERO database and assigned the identifier CRD42019103313.
High-intensity interval training (HIIT) has been suggested as an effective alternative to traditional moderate-intensity continuous training (MICT) that can yield improvements in a variety of health outcomes. Yet, despite the urgent need to find effective strategies for the treatment of pediatric obesity, only a few studies have addressed the impact of HIIT on eating behaviors and body composition in this population. This study aimed to compare the effect of HIIT versus MICT on eating behaviors in adolescents with obesity and to assess if the participants’ baseline dietary status is associated with the success of the intervention. Forty-three adolescents with obesity were randomly assigned to a 16-week MICT or HIIT intervention. Body composition and 24-h ad libitum energy intake were assessed at baseline and at the end of the program. Restrained eating, emotional eating, and external eating were assessed using the Dutch Eating Behavior Questionnaire at baseline. Both interventions led to significant weight, body mass index (BMI), and fat mass percentage (FM%) reductions, with better improvements in FM% in the HIIT group; whereas 24-h ad libitum energy intake increased to a similar extent in both groups. HIIT provides better body composition improvements over MICT, despite a similar increase in energy intake. Restrained eaters experienced less weight loss and smaller BMI reduction compared with unrestrained eaters; higher baseline cognitively restrained adolescents showed a greater increase of their ad libitum energy intake.
NoveltyHIIT favors better body composition improvements compared with MICT.
Both MICT and HIIT increased ad libitum energy intake in adolescents with obesity.
Weight loss achievement is better among unrestrained eaters.
The link between fibromyalgia syndrome (FMS) and obesity has not been thoroughly investigated. The purpose of this study was to examine the relationships among body mass index (BMI) and body composition parameters, including fat mass, fat mass percentage, and visceral fat, as well as FMS features, such as tender point count (TPC), pain, disease activity, fatigue, sleep quality, and anxiety, in a population of FMS women and healthy controls. A total of seventy-three women with FMS and seventy-three healthy controls, matched on weight, were included in this cross-sectional study. We used a body composition analyzer to measure fat mass, fat mass percentage, and visceral fat. Tender point count (TPC) was measured by algometry pressure. The disease severity was measured with the Fibromyalgia Impact Questionnaire (FIQ-R) and self-reported global pain was evaluated with the visual analog scale (VAS). To measure the quality of sleep, fatigue, and anxiety we used the Pittsburgh Sleep Quality Questionnaire (PSQI), the Spanish version of the multidimensional fatigue inventory (MFI), and the Beck Anxiety Inventory (BAI), respectively. Of the women in this study, 38.4% and 31.5% were overweight and obese, respectively. Significant differences in FIQ-R.1 (16.82 ± 6.86 vs. 20.66 ± 4.71, p = 0.030), FIQ-R.3 (35.20 ± 89.02 vs. 40.33 ± 5.60, p = 0.033), and FIQ-R total score (63.87 ± 19.12 vs. 75.94 ± 12.25, p = 0.017) among normal-weight and overweight FMS were observed. Linear analysis regression revealed significant associations between FIQ-R.2 (β(95% CI)= 0.336, (0.027, 0.645), p = 0.034), FIQ-R.3 (β(95% CI)= 0.235, (0.017, 0.453), p = 0.035), and FIQ-R total score (β(95% CI)= 0.110, (0.010, 0.209), p = 0.032) and BMI in FMS women after adjusting for age and menopause status. Associations between sleep latency and fat mass percentage in FMS women (β(95% CI)= 1.910, (0.078, 3.742), p = 0.041) and sleep quality and visceral fat in healthy women (β(95% CI)= 2.614, (2.192, 3.036), p = 0.008) adjusted for covariates were also reported. The higher BMI values are associated with poor FIQ-R scores and overweight and obese women with FMS have higher symptom severity. The promotion of an optimal BMI might contribute to ameliorate some of the FMS symptoms.
Objective
The purpose of this study was to evaluate the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on cardiovascular disease (CVD) risk factors in adults with overweight and obesity.
Methods
Twenty-two articles were included by searching six databases, the total number of subjects was 620 in these articles. Outcomes were synthesised using a random-effects meta-analysis of the Standardized mean difference (SMD) in CVD risk factors.
Results
HIIT and MICT resulted in statistically significant reductions in Weight, BMI, fat%, total cholesterol(TC), and improvement in VO2max. Compared with MICT, subgroup of durations of HIIT training interval ≥2 min can significantly increase VO2max (SMD = 0.444, 95% CI:0.037~0.851,P = 0.032), subgroup of energy expenditure of HIIT equal to MICT can significantly increase VO2max (SMD = 0.399, 95% CI:0.106~0.692,P = 0.008).
Conclusions
HIIT appears to provide similar benefits to MICT for improving body composition, VO2maxand TC, but HIIT spent less time than MICT by 9.7 min on one session. HIIT is superior to MICT in improving cardiopulmonary fitness when durations of HIIT training interval ≥2 min or energy expenditure of HIIT same as MICT. PROSPERO ID: CRD42016045835.
Introduction:
The Medical Outcome Study Short Form 36 (SF-36) is widely used for measuring Health-Related Quality of Life (HRQoL) and has undergone rigorous psychometric evaluation using Classic Test Theory (CTT). However, Item Response Theory-based evaluation of the SF-36 has been limited with an overwhelming focus on individual scales and cross-sectional data.
Purpose:
This study aimed to examine the longitudinal item and category stability of the SF-36 using Rasch analysis.
Method:
Using data from the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health, responses of the SF-36 from six waves of data collection were analysed. Rasch analysis using Winsteps version 3.92.0 was performed on all 36 items of the SF-36 and items that constitute the physical health and mental health scales.
Results:
Rasch analysis revealed issues with the SF-36 not detected using classical methods. Redundancy was seen for items on the total measure and both scales across all waves of data. Person separation indexes indicate that the measure lacks sensitivity to discriminate between high and low performances in this sample. The presence of Differential Item Functioning suggests that responses to items were influenced by locality and marital status.
Conclusion:
Previous evaluations of the SF-36 have relied on cross-sectional data; however, the findings of the current study demonstrate the longitudinal efficacy of the measure. Application of the Rasch Measurement Model indicated issues with internal consistency, generalisability, and sensitivity when the measure was evaluated as a whole and as both physical and mental health summary scales. Implications for future research are discussed.
Background
Cardiac rehabilitation (CR) for patients with cardiovascular disease has traditionally involved low-to moderate-intensity continuous aerobic exercise training (MICT). There is growing and robust evidence that high-intensity interval training (HIIT) shows similar or greater efficacy compared with MICT across a range of cardiovascular and metabolic measures, in both healthy populations and populations with a chronic illness. However, there is understandable concern about the safety aspects of applying HIIT in CR settings. This systematic review analyzed safety data drawn from recent proof-of-concept studies of HIIT during CR among patients with cardiovascular disease.
Methods and Results
We included trials comparing HIIT with either MICT or usual care in patients with coronary artery disease or heart failure participating in tertiary care services, such as phase 2 (outpatient) CR. Adverse events occurring during or up to 4 hours after an exercise training session were collated. There were 23 studies included, which analyzed 1117 participants (HIIT=547; MICT=570). One major cardiovascular adverse event occurred in relation to an HIIT session, equating to 1 major cardiovascular event per 17 083 training sessions (11 333 training hours). One minor cardiovascular adverse events and 3 noncardiovascular adverse events (primarily musculoskeletal complaints) were also reported for HIIT. Two noncardiovascular events were reported in relation to MICT.
Conclusions
HIIT has shown a relatively low rate of major adverse cardiovascular events for patients with coronary artery disease or heart failure when applied within CR settings.
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.
Background
High-intensity interval training (HIIT) is promoted as a time-efficient strategy to improve body composition. Objective
The aim of this meta-analysis was to assess the efficacy of HIIT in reducing total, abdominal, and visceral fat mass in normal-weight and overweight/obese adults. Methods
Electronic databases were searched to identify all related articles on HIIT and fat mass. Stratified analysis was performed using the nature of HIIT (cycling versus running, target intensity), sex and/or body weight, and the methods of measuring body composition. Heterogeneity was also determined ResultsA total of 39 studies involving 617 subjects were included (mean age 38.8 years ± 14.4, 52% females). HIIT significantly reduced total (p = 0.003), abdominal (p = 0.007), and visceral (p = 0.018) fat mass, with no differences between the sexes. A comparison showed that running was more effective than cycling in reducing total and visceral fat mass. High-intensity (above 90% peak heart rate) training was more successful in reducing whole body adiposity, while lower intensities had a greater effect on changes in abdominal and visceral fat mass. Our analysis also indicated that only computed tomography scan or magnetic resonance imaging showed significant abdominal and/or visceral fat-mass loss after HIIT interventions. ConclusionHIIT is a time-efficient strategy to decrease fat-mass deposits, including those of abdominal and visceral fat mass. There was some evidence of the greater effectiveness of HIIT running versus cycling, but owing to the wide variety of protocols used and the lack of full details about cycling training, further comparisons need to be made. Large, multicenter, prospective studies are required to establish the best HIIT protocols for reducing fat mass according to subject characteristics.
Background:
Exercise training is commonly recommended for individuals with fibromyalgia. This review is one of a series of reviews about exercise training for people with fibromyalgia that will replace the "Exercise for treating fibromyalgia syndrome" review first published in 2002.
Objectives:
• To evaluate the benefits and harms of aerobic exercise training for adults with fibromyalgia• To assess the following specific comparisons ० Aerobic versus control conditions (eg, treatment as usual, wait list control, physical activity as usual) ० Aerobic versus aerobic interventions (eg, running vs brisk walking) ० Aerobic versus non-exercise interventions (eg, medications, education) We did not assess specific comparisons involving aerobic exercise versus other exercise interventions (eg, resistance exercise, aquatic exercise, flexibility exercise, mixed exercise). Other systematic reviews have examined or will examine these comparisons (Bidonde 2014; Busch 2013).
Search methods:
We searched the Cochrane Library, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), Thesis and Dissertation Abstracts, the Allied and Complementary Medicine Database (AMED), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and the ClinicalTrials.gov registry up to June 2016, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.
Selection criteria:
We included randomized controlled trials (RCTs) in adults with a diagnosis of fibromyalgia that compared aerobic training interventions (dynamic physical activity that increases breathing and heart rate to submaximal levels for a prolonged period) versus no exercise or another intervention. Major outcomes were health-related quality of life (HRQL), pain intensity, stiffness, fatigue, physical function, withdrawals, and adverse events.
Data collection and analysis:
Two review authors independently selected trials for inclusion, extracted data, performed a risk of bias assessment, and assessed the quality of the body of evidence for major outcomes using the GRADE approach. We used a 15% threshold for calculation of clinically relevant differences between groups.
Main results:
We included 13 RCTs (839 people). Studies were at risk of selection, performance, and detection bias (owing to lack of blinding for self-reported outcomes) and had low risk of attrition and reporting bias. We prioritized the findings when aerobic exercise was compared with no exercise control and present them fully here.Eight trials (with 456 participants) provided low-quality evidence for pain intensity, fatigue, stiffness, and physical function; and moderate-quality evidence for withdrawals and HRQL at completion of the intervention (6 to 24 weeks). With the exception of withdrawals and adverse events, major outcome measures were self-reported and were expressed on a 0 to 100 scale (lower values are best, negative mean differences (MDs)/standardized mean differences (SMDs) indicate improvement). Effects for aerobic exercise versus control were as follows: HRQL: mean 56.08; five studies; N = 372; MD -7.89, 95% CI -13.23 to -2.55; absolute improvement of 8% (3% to 13%) and relative improvement of 15% (5% to 24%); pain intensity: mean 65.31; six studies; N = 351; MD -11.06, 95% CI -18.34 to -3.77; absolute improvement of 11% (95% CI 4% to 18%) and relative improvement of 18% (7% to 30%); stiffness: mean 69; one study; N = 143; MD -7.96, 95% CI -14.95 to -0.97; absolute difference in improvement of 8% (1% to 15%) and relative change in improvement of 11.4% (21.4% to 1.4%); physical function: mean 38.32; three studies; N = 246; MD -10.16, 95% CI -15.39 to -4.94; absolute change in improvement of 10% (15% to 5%) and relative change in improvement of 21.9% (33% to 11%); and fatigue: mean 68; three studies; N = 286; MD -6.48, 95% CI -14.33 to 1.38; absolute change in improvement of 6% (12% improvement to 0.3% worse) and relative change in improvement of 8% (16% improvement to 0.4% worse). Pooled analysis resulted in a risk ratio (RR) of moderate quality for withdrawals (17 per 100 and 20 per 100 in control and intervention groups, respectively; eight studies; N = 456; RR 1.25, 95%CI 0.89 to 1.77; absolute change of 5% more withdrawals with exercise (3% fewer to 12% more).Three trials provided low-quality evidence on long-term effects (24 to 208 weeks post intervention) and reported that benefits for pain and function persisted but did not for HRQL or fatigue. Withdrawals were similar, and investigators did not assess stiffness and adverse events.We are uncertain about the effects of one aerobic intervention versus another, as the evidence was of low to very low quality and was derived from single trials only, precluding meta-analyses. Similarly, we are uncertain of the effects of aerobic exercise over active controls (ie, education, three studies; stress management training, one study; medication, one study) owing to evidence of low to very low quality provided by single trials. Most studies did not measure adverse events; thus we are uncertain about the risk of adverse events associated with aerobic exercise.
Authors' conclusions:
When compared with control, moderate-quality evidence indicates that aerobic exercise probably improves HRQL and all-cause withdrawal, and low-quality evidence suggests that aerobic exercise may slightly decrease pain intensity, may slightly improve physical function, and may lead to little difference in fatigue and stiffness. Three of the reported outcomes reached clinical significance (HRQL, physical function, and pain). Long-term effects of aerobic exercise may include little or no difference in pain, physical function, and all-cause withdrawal, and we are uncertain about long-term effects on remaining outcomes. We downgraded the evidence owing to the small number of included trials and participants across trials, and because of issues related to unclear and high risks of bias (performance, selection, and detection biases). Aerobic exercise appears to be well tolerated (similar withdrawal rates across groups), although evidence on adverse events is scarce, so we are uncertain about its safety.
Objective:
The objective of this study is to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) for improvements in body composition in overweight and obese adults.
Methods:
Trials comparing HIIT and MICT in overweight or obese participants aged 18-45 years were included. Direct measures (e.g. whole-body fat mass) and indirect measures (e.g. waist circumference) were examined.
Results:
From 1,334 articles initially screened, 13 were included. Studies averaged 10 weeks × 3 sessions per week training. Both HIIT and MICT elicited significant (p < 0.05) reductions in whole-body fat mass and waist circumference. There were no significant differences between HIIT and MICT for any body composition measure, but HIIT required ~40% less training time commitment. Running training displayed large effects on whole-body fat mass for both HIIT and MICT (standardized mean difference -0.82 and -0.85, respectively), but cycling training did not induce fat loss.
Conclusions:
Short-term moderate-intensity to high-intensity exercise training can induce modest body composition improvements in overweight and obese individuals without accompanying body-weight changes. HIIT and MICT show similar effectiveness across all body composition measures suggesting that HIIT may be a time-efficient component of weight management programs.
Although moderate-intensity continuous training (MICT) has been the traditional model for aerobic exercise training for over four decades, a growing body of literature has demonstrated equal if not greater improvement in aerobic capacity and similar beneficial effects on body composition, glucose metabolism, blood pressure, and quality of life from high-intensity interval training (HIIT). An advantage of HIIT over MICT is the shorter time required to perform the same amount of energy expenditure. The current brief review summarizes the effects of HIIT on peak aerobic capacity and cardiovascular risk factors in healthy adults and those with various cardiovascular diseases, including coronary artery disease, chronic heart failure, and post heart transplantation.
Objective
The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.
Methods
A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.
Results
2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).
Conclusions
These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.
High-intensity interval training has recently emerged as superior to continuous endurance training in cardiac rehabilitation upon other training regimes. Individually tailored continuous endurance training and pyramid training could induce comparable effects on peak work capacity as high intensity interval training.
A prospective, randomized study.
Effects of the following isocaloric cycle ergometer protocols on peak work capacity have been assessed in patients with coronary artery disease (n = 60) during 6 weeks of outpatient cardiac rehabilitation, i.e. 18 supervised sessions of exercise training: (1) continuous endurance training (n = 20): 33 min at 65-85% peak heart rate; (2) high intensity interval training (n = 20): 4 × 4 min intervals at 85-95% peak heart rate, each followed by 3 min of active recovery at 60-70% peak heart rate; (3) pyramid training (n = 20): 3 × 8 min of stepwise load increase and subsequent decrease from 65-95-65% peak heart rate, supplemented by 2 min recovery at 60-70% peak heart rate between pyramids. All protocols were preceded by 5 min of warm-up and followed by 5 min cool-down at 60-70% peak heart rate.
Attendance during exercise sessions was 99.2%. There were significant increases in peak work capacity of comparable magnitude in all three training groups (begin vs. end: continuous endurance training: 136.0 ± 49.6 W vs. 163.4 ± 60.8 W (21.1 ± 8.5%); high-intensity interval training: 141.0 ± 60.4 W vs. 171.1 ± 69.8 W (22.8 ± 6.6%); pyramid training: 128.7 ± 50.6 W vs. 158.5 ± 57.9 W (24.8 ± 10.8%); within groups all p < 0.001; between groups, p = not significant).
Endurance training protocols assessed in this study all led to significant increases in peak work capacity of comparable magnitude. Our findings suggest that these protocols can be used interchangeably, which will lead to further individualization of exercise prescription and may therefore result in improved adherence to lifelong behavioural changes.
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Studying the epidemiology of fibromyalgia (FM) is very important to understand the impact of this disorder on persons, families and society. The recent modified 2010 classification criteria of the American College of Rheumatology (ACR), without the need of tender points palpation, allows that larger and nationwide surveys may be done, worldwide. This article reviews the prevalence and incidence studies done in the general population, in several countries/continents, the prevalence of FM in special groups/settings, the association of FM with some sociodemographic characteristics of the population, and the comorbidity of FM with others disorders, especially with headaches.
Physical inactivity is a global problem which is related to many chronic health disorders. Physical activity scales which allow cross-cultural comparisons have been developed. The goal was to assess the reliability and validity of a Turkish version of the International Physical Activity Questionnaire (IPAQ). 1,097 university students (721 women, 376 men; ages 18–32) volunteered. Short and long forms of the IPAQ gave good agreement and comparable 1-wk. test-retest reliabilities. Caltrac accelerometer data were compared with IPAQ scores in 80 participants with good agreement for short and long forms. Turkish versions of the IPAQ short and long forms are reliable and valid in assessment of physical activity.
The efficacy and the optimal type and volume of aerobic exercise (AE) in fibromyalgia syndrome (FMS) are not established. We therefore assessed the efficacy of different types and volumes of AE in FMS.
The Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDISCUS (through April 2009) and the reference sections of original studies and systematic reviews on AE in FMS were systematically reviewed. Randomised controlled trials (RCTs) of AE compared with controls (treatment as usual, attention placebo, active therapy) and head-to-head comparisons of different types of AE were included. Two authors independently extracted articles using predefined data fields, including study quality indicators.
Twenty-eight RCTs comparing AE with controls and seven RCTs comparing different types of AE with a total of 2,494 patients were reviewed. Effects were summarised using standardised mean differences (95% confidence intervals) by random effect models. AE reduced pain (-0.31 (-0.46, -0.17); P<0.001), fatigue (-0.22 (-0.38, -0.05); P=0.009), depressed mood (-0.32 (-0.53, -0.12); P=0.002) and limitations of health-related quality of life (HRQOL) (-0.40 (-0.60, -0.20); P<0.001), and improved physical fitness (0.65 (0.38, 0.95); P<0.001), post treatment. Pain was significantly reduced post treatment by land-based and water-based AE, exercises with slight to moderate intensity and frequency of two or three times per week. Positive effects on depressed mood, HRQOL and physical fitness could be maintained at follow-up. Continuing exercise was associated with positive outcomes at follow-up. Risks of bias analyses did not change the robustness of the results. Few studies reported a detailed exercise protocol, thus limiting subgroup analyses of different types of exercise.
An aerobic exercise programme for FMS patients should consist of land-based or water-based exercises with slight to moderate intensity two or three times per week for at least 4 weeks. The patient should be motivated to continue exercise after participating in an exercise programme.
Fibromyalgia is a painful, debilitating illness with a prevalence of 0.5-5.0% that affects women more than men. It has been shown that the diagnosis of fibromyalgia is associated with improved patient satisfaction and reduced healthcare utilization. This survey examined the patient journey to having their condition diagnosed and studied the impact of the condition on their life.
A questionnaire survey of 800 patients with fibromyalgia and 1622 physicians in 6 European countries, Mexico and South Korea. Patients were recruited via their physician.
Over half the patients (61%) were aged 36-59 years, 84% were women, and the mean time since experiencing fibromyalgia symptoms was 6.5 years. Patients had experienced multiple fibromyalgia symptoms (mean of 7.3 out of 14), with pain, fatigue, sleeping problems and concentration difficulties being the most commonly reported. Most patients rated their chronic widespread pain as moderate or severe and fibromyalgia symptoms were on average "fairly" to "very" disruptive, and had a "moderate" to "strong" impact on patients' lives. 22% were unable to work and 25% were not able to work all the time because of their fibromyalgia. Patients waited on average almost a year after experiencing symptoms before presenting to a physician, and it took an average of 2.3 years and presenting to 3.7 different physicians before receiving a diagnosis of fibromyalgia. Patients rated receiving a diagnosis as somewhat difficult on average and had difficulties communicating their symptoms to the physician. Over one third (35%) felt their chronic widespread pain was not well managed by their current treatment.
This survey provides further evidence that fibromyalgia is characterized by multiple symptoms and has a notable impact on quality of life and function. The diagnosis of fibromyalgia is delayed. Patients wait a significant period of time before presenting to a physician, adding to the prolonged time to diagnosis. Patients typically present with a multitude of symptoms, all resulting in a delay in diagnosis and eventual management. Helping clinicians to diagnose and manage patients with fibromyalgia should benefit both patients and funders of healthcare.
Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. This is an update of a review published in Issue 2, 2002.
The primary objective of this systematic review was to evaluate the effects of exercise training including cardiorespiratory (aerobic), muscle strengthening, and/or flexibility exercise on global well-being, selected signs and symptoms, and physical function in individuals with FMS.
We searched MEDLINE, EMBASE, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials (CENTRAL, Issue 3, 2005) up to and including July 2005. We also reviewed reference lists from reviews and meta-analyses of treatment studies.
Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected.
Two of four reviewers independently extracted data for each study. All discrepancies were rechecked and consensus achieved by discussion. Methodological quality was assessed by two instruments: the van Tulder and the Jadad methodological quality criteria. We used the American College of Sport Medicine (ACSM) guidelines to evaluate whether interventions had provided a training stimulus that would effect changes in physical fitness. Due to significant clinical heterogeneity among the studies we were only able to meta-analyze six aerobic-only studies and two strength-only studies.
There were a total of 2276 subjects across the 34 included studies; 1264 subjects were assigned to exercise interventions. The 34 studies comprised 47 interventions that included exercise. Effects of several disparate interventions on global well-being, selected signs and symptoms, and physical function in individuals with FMS were summarized using standardized mean differences (SMD). There is moderate quality evidence that aerobic-only exercise training at recommended intensity levels has positive effects global well-being (SMD 0.44, 95% confidence interval (CI 0.13 to 0.75) and physical function (SMD 0.68, 95% CI 0.41 to 0.95) and possibly on pain (SMD 0.94, 95% CI -0.15 to 2.03) and tender points (SMD 0.26, 95% CI -0.28 to 0.79). Strength and flexibility remain under-evaluated.
There is 'gold' level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed.
To determine the reliability and concurrent validity of a visual analogue scale (VAS) for disability as a single-item instrument measuring disability in chronic pain patients was the objective of the study. For the reliability study a test-retest design and for the validity study a cross-sectional design was used. A general rehabilitation centre and a university rehabilitation centre was the setting for the study. The study population consisted of patients over 18 years of age, suffering from chronic musculoskeletal pain; 52 patients in the reliability study, 344 patients in the validity study. Main outcome measures were as follows. Reliability study: Spearman's correlation coefficients (rho values) of the test and retest data of the VAS for disability; validity study: rho values of the VAS disability scores with the scores on four domains of the Short-Form Health Survey (SF-36) and VAS pain scores, and with Roland-Morris Disability Questionnaire scores in chronic low back pain patients. Results were as follows: in the reliability study rho values varied from 0.60 to 0.77; and in the validity study rho values of VAS disability scores with SF-36 domain scores varied from 0.16 to 0.51, with Roland-Morris Disability Questionnaire scores from 0.38 to 0.43 and with VAS pain scores from 0.76 to 0.84. The conclusion of the study was that the reliability of the VAS for disability is moderate to good. Because of a weak correlation with other disability instruments and a strong correlation with the VAS for pain, however, its validity is questionable.
We aimed to analyze the evidence on the effects of physical exercise in patients with fibromyalgia (FM) and to assess the characteristics of published studies, especially the quality of the evidence, through an umbrella review. This umbrella review followed the PRISMA guidelines and was documented in the PROSPERO registry (CRD42017075687). We searched the PubMed, Web of Science, SportDiscus, Scopus, Cinahl, and Cochrane Library databases. The methodological quality of systematic reviews was assessed using AMSTAR 2. We only selected systematic reviews (with or without meta-analyses) investigating the effects of any type of physical exercise in patients with FM syndrome. Thirty-seven systematic reviews (total = 477) fulfilled the criteria. Most studies were rated as being of low or moderate quality. A variety of exercises were used as treatment for FM symptoms, with positive results. Most of the reviews investigated the effects of aerobic exercise and strength training. No serious adverse events were reported. The largest effects of exercise were seen in terms of improved pain intensity and quality of life. Altogether, exercise may be an effective treatment for FM symptoms. Thus, aerobic exercise and strength training are effective programs for the treatment of FM. By summarizing the findings and effect sizes of the reviewed studies, we observed that the evidence for improvement of pain level and quality of life was the strongest. The results have potential to influence evidence-based practice. Future studies should analyze the long-term effects of exercise.
Recently, high-intensity interval training (HIIT) has been recognized as a safe and effective alternative to moderate-intensity continuous training for older patients with cardiovascular disease (CVD) in cardiac rehabilitation settings in an effort to improve health outcomes. This brief review considers general principles and suggestions for prescription of HIIT for older patients with CVD, specific challenges pertaining to older adults, the physiologic mechanisms by which HIIT contributes to improvements in peak Vo2, and the effects of HIIT on cardiovascular health in older patients with coronary artery disease and heart failure.
Background:
Exercise training is commonly recommended for individuals with fibromyalgia. This review is one of a series of reviews about exercise training for fibromyalgia that will replace the review titled "Exercise for treating fibromyalgia syndrome", which was first published in 2002.
Objectives:
To evaluate the benefits and harms of mixed exercise training protocols that include two or more types of exercise (aerobic, resistance, flexibility) for adults with fibromyalgia against control (treatment as usual, wait list control), non exercise (e.g. biofeedback), or other exercise (e.g. mixed versus flexibility) interventions.Specific comparisons involving mixed exercise versus other exercises (e.g. resistance, aquatic, aerobic, flexibility, and whole body vibration exercises) were not assessed.
Search methods:
We searched the Cochrane Library, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Thesis and Dissertations Abstracts, the Allied and Complementary Medicine Database (AMED), the Physiotherapy Evidence Databese (PEDro), Current Controlled Trials (to 2013), WHO ICTRP, and ClinicalTrials.gov up to December 2017, unrestricted by language, to identify all potentially relevant trials.
Selection criteria:
We included randomised controlled trials (RCTs) in adults with a diagnosis of fibromyalgia that compared mixed exercise interventions with other or no exercise interventions. Major outcomes were health-related quality of life (HRQL), pain, stiffness, fatigue, physical function, withdrawals, and adverse events.
Data collection and analysis:
Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias and the quality of evidence for major outcomes using the GRADE approach.
Main results:
We included 29 RCTs (2088 participants; 98% female; average age 51 years) that compared mixed exercise interventions (including at least two of the following: aerobic or cardiorespiratory, resistance or muscle strengthening exercise, and flexibility exercise) versus control (e.g. wait list), non-exercise (e.g. biofeedback), and other exercise interventions. Design flaws across studies led to selection, performance, detection, and selective reporting biases. We prioritised the findings of mixed exercise compared to control and present them fully here.Twenty-one trials (1253 participants) provided moderate-quality evidence for all major outcomes but stiffness (low quality). With the exception of withdrawals and adverse events, major outcome measures were self-reported and expressed on a 0 to 100 scale (lower values are best, negative mean differences (MDs) indicate improvement; we used a clinically important difference between groups of 15% relative difference). Results for mixed exercise versus control show that mean HRQL was 56 and 49 in the control and exercise groups, respectively (13 studies; 610 participants) with absolute improvement of 7% (3% better to 11% better) and relative improvement of 12% (6% better to 18% better). Mean pain was 58.6 and 53 in the control and exercise groups, respectively (15 studies; 832 participants) with absolute improvement of 5% (1% better to 9% better) and relative improvement of 9% (3% better to 15% better). Mean fatigue was 72 and 59 points in the control and exercise groups, respectively (1 study; 493 participants) with absolute improvement of 13% (8% better to 18% better) and relative improvement of 18% (11% better to 24% better). Mean stiffness was 68 and 61 in the control and exercise groups, respectively (5 studies; 261 participants) with absolute improvement of 7% (1% better to 12% better) and relative improvement of 9% (1% better to 17% better). Mean physical function was 49 and 38 in the control and exercise groups, respectively (9 studies; 477 participants) with absolute improvement of 11% (7% better to 15% better) and relative improvement of 22% (14% better to 30% better). Pooled analysis resulted in a moderate-quality risk ratio for all-cause withdrawals with similar rates across groups (11 per 100 and 12 per 100 in the control and intervention groups, respectively) (19 studies; 1065 participants; risk ratio (RR) 1.02, 95% confidence interval (CI) 0.69 to 1.51) with an absolute change of 1% (3% fewer to 5% more) and a relative change of 11% (28% fewer to 47% more). Across all 21 studies, no injuries or other adverse events were reported; however some participants experienced increased fibromyalgia symptoms (pain, soreness, or tiredness) during or after exercise. However due to low event rates, we are uncertain of the precise risks with exercise. Mixed exercise may improve HRQL and physical function and may decrease pain and fatigue; all-cause withdrawal was similar across groups, and mixed exercises may slightly reduce stiffness. For fatigue, physical function, HRQL, and stiffness, we cannot rule in or out a clinically relevant change, as the confidence intervals include both clinically important and unimportant effects.We found very low-quality evidence on long-term effects. In eight trials, HRQL, fatigue, and physical function improvement persisted at 6 to 52 or more weeks post intervention but improvements in stiffness and pain did not persist. Withdrawals and adverse events were not measured.It is uncertain whether mixed versus other non-exercise or other exercise interventions improve HRQL and physical function or decrease symptoms because the quality of evidence was very low. The interventions were heterogeneous, and results were often based on small single studies. Adverse events with these interventions were not measured, and thus uncertainty surrounds the risk of adverse events.
Authors' conclusions:
Compared to control, moderate-quality evidence indicates that mixed exercise probably improves HRQL, physical function, and fatigue, but this improvement may be small and clinically unimportant for some participants; physical function shows improvement in all participants. Withdrawal was similar across groups. Low-quality evidence suggests that mixed exercise may slightly improve stiffness. Very low-quality evidence indicates that we are 'uncertain' whether the long-term effects of mixed exercise are maintained for all outcomes; all-cause withdrawals and adverse events were not measured. Compared to other exercise or non-exercise interventions, we are uncertain about the effects of mixed exercise because we found only very low-quality evidence obtained from small, very heterogeneous trials. Although mixed exercise appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events is scarce, so we are uncertain about its safety. We downgraded the evidence from these trials due to imprecision (small trials), selection bias (e.g. allocation), blinding of participants and care providers or outcome assessors, and selective reporting.
Background:
Patients with primary symptoms of fibromyalgia (FM) have a lower quality of life than healthy people of the same age. The current treatment for FM is palliative, as there is no cure. Therefore, among strategies used to alleviate the symptoms, physical exercise has been recommended.
Objective:
To investigate the effects of a resistance training (RT) program on quality of life and associated factors in patients with FM.
Design:
Non-randomized clinical trial.
Patients:
Forty-nine women with FM (age: 51.35 ± 9.34 years) allocated to a RT group (n=26) or control group (CG; n=23).
Methods:
The intervention consisted of 4 weeks of a supervised RT program. Three 60-min training sessions per week were conducted. Participants were evaluated before and after 4 weeks of exercise intervention.
Main outcome measurements:
The Fibromyalgia Impact Questionnaire was used to assess quality of life, and secondary outcomes were assessed with the Pittsburgh Sleep Quality Inventory, Beck Depression Inventory, and Beck Anxiety Inventory. The Wilcoxon test was used to verify the differences after 4 weeks of intervention (12 sessions) and the Mann-Whitney U test was used to compare the results for the RT and CG.
Results:
The results demonstrated that 4 weeks of RT reduces the impact of FM on quality of life, depression, and anxiety (p<.05). Higher depression and anxiety scores were related to worsening quality of life. The CG did not show significant changes.
Conclusions:
RT reduces the impact of FM on the quality of life, anxiety and depression in women with FM.
Objective:
The study aimed to investigate the effect of an 8-wk structured strength training program on pain and sleep quality in patients with fibromyalgia.
Design:
Fifty-two patients with fibromyalgia were evaluated; 31 submitted to strength training and 21 comprised the control group. The instruments used were the Fibromyalgia Impact Questionnaire and The Pittsburgh Sleep Quality Index. The questionnaires were applied before the first training session, at 12 sessions, and after 24 sessions. Descriptive statistics (mean, SD, and frequency) and inferential tests were used.
Results:
After 8 wks of intervention, significant differences were found between groups in subjective quality of sleep (P = 0.03), sleep disturbance (P = 0.02), daytime dysfunction (P = 0.04), and total sleep score (P < 0.01). The correlation analysis using Spearman's test indicated a positive relationship between the variables of pain intensity and sleep quality (P < 0.01); when pain intensity increased in patients with fibromyalgia, sleep quality worsened.
Conclusions:
Strength training is safe and effective in treating people with fibromyalgia, and a significant decrease in sleep disturbances occurs after 8 wks of intervention.
For the secondary prevention of cardiovascular disease, comprehensive cardiac rehabilitation is required. This involves optimal medical therapy, education on nutrition and exercise therapy, and smoking cessation. Of these, efficient exercise therapy is a key factor. A highly effective training protocol is therefore warranted, which requires a high rate of compliance. Although moderate-intensity continuous training has been the main training regimen recommended in cardiac rehabilitation guidelines, high-intensity interval training has been reported to be more effective in the clinical and experimental setting from the standpoint of peak oxygen uptake and central and peripheral adaptations. In this review, we illustrate the scientific evidence for high-intensity interval training. We then verify this evidence and discuss its significance and the remaining issues.
BACKGROUND:
The relationship between estimates of total and central body fat with fibromyalgia pain, fatigue and overall impact has not been fully described. We aimed to assess the individual and combined association of body fat (total and central) with pain, fatigue and the overall impact in fibromyalgia women; and to study the possible mediation role of physical fitness in these associations.
METHODS:
A total of 486 fibromyalgia women with a mean (standard deviation) age of 52.2 (8.0) years participated. Pain was measured with self-reported measures and algometry, whereas fatigue with the Multidimensional Fatigue Inventory. The impact of fibromyalgia was measured with the Revised Fibromyalgia Impact Questionnaire (FIQR) total score. Total and central body fat were assessed by means of bioelectrical impedance and waist circumference, respectively. The Functional Senior Fitness Test battery and the handgrip strength test were used to assess physical fitness.
RESULTS:
Total and central body fat were positively associated with pain- and fatigue-related measures and the FIQR total score (β from 0.10 to 0.25; all, p < 0.05). A combined effect of total and central body fat was observed on pain (FIQR and 36-item Short-Form Health Survey), general and physical-related fatigue and FIQR total score (all, overall p < 0.05), so that the group with no total and central obesity had more favourable results than those with total and central obesity. Cardiorespiratory fitness partially mediated (between 22-40% of the total effect) the associations between total and central body fat with pain, general fatigue, physical fatigue and reduced activity, and largely mediated (80%) the association of central body fat with the FIQR total score.
CONCLUSIONS:
Physical fitness might potentially explain the association between obesity and fibromyalgia symptoms
To investigate the effects of supervised aerobic exercise (AE) and a combined program of supervised aerobic, muscle strengthening, and flexibility exercises (combined exercise [CE]) on important health outcomes in women with fibromyalgia syndrome (FMS).
Randomized controlled trial.
Community-based supervised intervention.
Women (N=64) with a diagnosis of FMS according to the American College of Rheumatology criteria.
Participants were randomly allocated to 1 of 3 groups: supervised AE, supervised CE, or usual-care control. Exercise sessions were performed twice weekly (45-60min/session) for 24 weeks.
The primary outcome measure was the Fibromyalgia Impact Questionnaire (FIQ). Exploratory outcome measures were the 36-Item Short-Form Health Survey, Beck Depression Inventory (BDI), aerobic capacity (6-minute walk test), hand-grip strength, and range of motion in the shoulders and hips.
Compliance with both interventions was excellent, with women in the exercise groups attending more than 85% of sessions. A 14% to 15% improvement from baseline in total FIQ score was observed in the exercise groups (P≤.02) and was accompanied by decreases in BDI scores of 8.5 (P<.001) and 6.4 (P<.001) points in the AE and CE groups, respectively. Relative to nonexercising controls, CE evoked improvements in the SF-36 Physical Functioning (P=.003) and Bodily Pain (P=.003) domains and was more effective than AE for evoking improvements in the Vitality (P=.002) and Mental Health (P=.04) domains. Greater improvements also were observed in shoulder/hip range of motion and handgrip strength in the CE group.
Given the equivalent time commitment required for AE and CE, our results suggest that women with FMS can gain additional health benefits by engaging in a similar volume of CE.
The purpose of this study was to examine the influence of a preferred- versus a prescribed-intensity exercise session on pain in women with fibromyalgia (FM).
Twenty-one women with FM (mean age = 44 yr) completed two randomly assigned exercise sessions consisting of 20 min of cycle ergometry at a self-selected intensity and a prescribed intensity. Experimental pain perception was assessed before and after aerobic exercise. During exercise, HR, watts, RPE, and muscle pain were assessed every 5 min. Clinical pain was assessed with the Short-Form McGill Pain Questionnaire (SF-MPQ) immediately and 24, 48, 72, and 96 h after exercise. Data were analyzed with repeated-measures ANOVA.
Women with FM preferred a lower intensity of exercise than what was prescribed as indicated by significantly lower HR, watts, and RPE responses (P < 0.05). Muscle pain in the legs, however, was similar in the two conditions and significantly increased during exercise (P < 0.05). Pain thresholds and pain tolerances increased significantly after exercise, whereas peak pain ratings decreased after exercise (P < 0.05). Furthermore, pain (SF-MPQ) in the follow-up period was found to be lower than baseline (P < 0.05).
It is concluded that the women with FM who participated in this study experienced significant improvements in pain after exercise. The results from this study are novel and indicate that recommendations for exercise prescription for individuals with FM should consider the preferred-intensity exercise model as a strategy to reduce pain.
This study was undertaken to translate and adapt the Fibromyalgia Impact Questionnaire (FIQ) into the Turkish language and investigate its validity and reliability for Turkish female fibromyalgia (FM) patients. After translation into Turkish, we administered the FIQ and Health Assessment Questionnaire (HAQ) to 51 women with fibromyalgia. As well as sociodemographic characteristics, the severity of relevant clinical symptoms, e.g., pain intensity, fatigue, and sleep disturbance, were assessed by visual analog scales. A tender point score (TPS) was calculated from tender points conducted by thumb palpation. Test-retest reliability, internal consistency, and concurrent and construct validities of FIQ were evaluated. Test-retest reliability and internal consistency were good at 0.81 and 0.72, respectively. Correlation between FIQ and HAQ scores was 0.43, which was low but statistically significant. Significant moderate correlations were obtained between the FIQ items and severity of clinical symptoms (0.63-0.77), except TPS, 0.31. The FIQ is a reliable and valid instrument for measuring functional disability in Turkish female FM patients.
Increased aerobic exercise capacity appears to reduce both all-cause mortality and cardiovascular disease mortality. Physical exercise to improve peak oxygen uptake (VO2peak) is thus strongly recommended, however evidence regarding the most efficient training intensity for patients with coronary artery disease (CAD) is still lacking. The purpose of this randomized study was therefore to assess the effects of high intensity aerobic interval exercise compared to moderate intensity exercise, representing the same total training load, for increasing VO2peak in stable CAD-patients.
Twenty-one stable CAD-patients were randomized to supervised treadmill walking at either high intensity (80-90% of VO2peak) or moderate intensity (50-60% of VO2peak) three times a week for 10 weeks.
After training VO2peak increased by 17.9% (P=0.012) in the high intensity group and 7.9% (P=0.038) in the moderate intensity group. The training-induced adaptation was significantly higher in the high intensity group (P=0.011).
High intensity aerobic interval exercise is superior to moderate exercise for increasing VO2peak in stable CAD-patients. As VO2peak seems to reflect a continuum between health and cardiovascular disease and death, the present data may be useful in designing effective training programmes for improved health in the future.
To identify predictors of maintenance of exercise for women with fibromyalgia (FM).
Women with FM who had been randomized to the exercise arm of a clinical trial were studied prospectively during and 3 months following treatment. Subjects completed exercise logs weekly and returned the data via postal mail. Outcome variables were duration of aerobic and stretching exercises. Two separate multivariate models for longitudinal data were built with adjustment for in-treatment adherence and time. Pretreatment characteristics (self efficacy, pain, disability, stress, exercise barriers and benefits, and age) and changes during treatment (pain, disability, stress, and exercise barriers and benefits) were considered potential predictors of exercise maintenance.
Stretching significantly decreased in the 3 months following treatment. High stress at baseline and increases in stress during treatment were associated with poor maintenance of stretching. Disability at baseline (measured with the Fibromyalgia Impact Questionnaire), an increase in barriers to exercise during treatment, and increases in upper-body pain during treatment were associated with worse maintenance of aerobic exercise in the 3 months following treatment.
The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress, pain, barriers to exercise, and disability.
ATS/ACCP statement on cardiopulmonary exercise testing
American Thoracic Society American College of Chest Physicians.
ATS/ACCP statement on cardiopulmonary exercise testing [published
correction appears in Am J Respir Crit Care Med 2003;1451-2].
Highintensity interval training versus continuous training on physiological and metabolic variables in prediabetes and type 2 diabetes: a meta-analysis
- A T De Nardi
- T Tolves
- T L Lenzi
- L U Signori
- Amvd Silva
De Nardi AT, Tolves T, Lenzi TL, Signori LU, Silva AMVD. Highintensity interval training versus continuous training on physiological and metabolic variables in prediabetes and type 2 diabetes:
a meta-analysis. Diabetes Res Clin Pract 2018;137:149-59.
ATS/ACCP statement on cardiopulmonary exercise testing [published correction appears in Am J Respir Crit Care Med 2003;1451-2]
- American Thoracic Society American College of Chest Physicians