Article

A randomized controlled trial of deep water running: Clinical effectiveness of aquatic exercise to treat fibromyalgia

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Abstract

To compare the clinical effectiveness of aerobic exercise in the water with walking/jogging for women with fibromyalgia (FM). Sixty sedentary women with FM, ages 18-60 years, were randomly assigned to either deep water running (DWR) or land-based exercises (LBE). Patients were trained for 15 weeks at their anaerobic threshold. Visual analog scale of pain, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory, Short Form 36 Health Survey (SF-36), and a patient's global assessment of response to therapy (PGART) were measured at baseline, week 8, and week 15. Statistical analysis included all patients. Four patients dropped out from each group. Both groups improved significantly at week 15 compared with baseline, with an average 36% reduction in pain intensity. For PGART, 40% of the DWR group and 30% of the LBE group answered "much better" at posttreatment. FIQ total score and FIQ depression improvements in the DWR group were faster (week 8) than the LBE group and kept improving (week 15; P < 0.05). Only the DWR group showed improvements in SF-36 role emotional (P = 0.006). No significant between-group differences were observed for peak oxygen uptake and other outcomes. DWR is a safe exercise that has been shown to be as effective as LBE regarding pain. However, it has been shown to bring more advantages related to emotional aspects. Aerobic gain was similar for both groups, regardless of symptom improvement. Therefore, DWR could be studied as an exercise option for patients with FM who have problems adapting to LBE or lower limbs limitations.

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... Five subscales, including reporting, external validity, internal validity in bias, confounding, and power were assessed according to the characteristics of reviewed studies. Scores for this tool can be interpreted as follows: Excellent (26)(27)(28); good (20)(21)(22)(23)(24)(25); fair (15)(16)(17)(18)(19); and poor (≤14) [17]. ...
... Following an initial search identification of 1416 articles, 11 articles were included in the review ( Figure 1) for quantitative synthesis. Of the eleven included studies, seven studies were randomized controlled trials (RCT)s [10,[19][20][21][22][23][24][25][26][27][28], two were longitudinal studies [19,21], and two were quasi-experiment studies [25,27]. ...
... Of the eleven included studies, seven studies were randomized controlled trials (RCT)s [10,[19][20][21][22][23][24][25][26][27][28], two were longitudinal studies [19,21], and two were quasi-experiment studies [25,27]. ...
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Deep Water Running (DWR) is a form of aquatic aerobic exercise simulating the running patterns adopted on dry land. Little is known on the effectiveness of DWR despite gaining popularity. The objective of this study is to systematically review the effects of DWR on cardiorespiratory fitness, physical function, and quality of life in healthy and clinical populations. A systematic search was completed using six databases, including SPORTDiscus, MEDLINE, CINAHL, AMED, Embase, and The Cochrane Library, up to February 2022. Eleven studies evaluating the effectiveness of DWR on cardiorespiratory fitness (CRF), physical function, or quality of life (QoL), compared with no interventions (or standard treatment) or land-based trainings were identified. Data relevant to the review questions were extracted by two independent reviewers when means and standard deviations were reported, and standardized mean differences were calculated. A quality assessment was conducted using selected items from the Downs and Black checklist. A total of 11 clinical trials (7 randomized controlled trials) with a total of 287 participants were included. Meta-analyses were not completed due to the high level of clinical and statistical heterogeneity between studies. Compared with land-based training, DWR showed similar effects on CRF with limited studies reporting outcomes of physical function and QoL compared with the no-exercise control group. DWR appears to be comparable to land-based training for improving CRF. The aquatic environment may provide some advantages for off-loaded exercise at high intensity in populations that are weak, injured or in pain, but more studies are required.
... The exclusion criteria were heterogeneous and included pregnancy [27,46,47,53,[59][60][61]63,71,74,82,83,86,88,98], neurological diseases [29,35,37,39,41,44,62,65,77,81,82,84,97], rheumatic diseases [29,32,33,39,[41][42][43][44]47,55,[57][58][59][60]65,74,77,79,80,83,88,91,94,98], psychological/psychiatric conditions [27,32,38,42,45,46,49,50,55,[59][60][61]63,64,66,69,70,[73][74][75][79][80][81][82][83]89,91,94], intake medication [32,35,41,44,49,54,57,58,64,66,75,95], diabetes mellitus [32,43,44,55,57,58,65,85], cancer [32,34,46,58,64,67,82,89], skin disorders [29,[50][51][52]92], trauma [59-61, 65,83,92], hypertension [32,[42][43][44]57,58,65,66,72], migraine [59][60][61]83], osteoarthritis [30,43,66,85,91], peripheral nerve entrapment [59][60][61]83], obesity [29,39,74], substance abuse [64,73,77], and hypotension [50,51,65]. It is important to mention that in 54.7% (n = 40/73) of clinical trials, people with cardiac, pulmonary or kidney diseases were excluded since these "visceral" conditions could limit the therapeutic intervention used in these trials (exercise). ...
... The exclusion criteria were heterogeneous and included pregnancy [27,46,47,53,[59][60][61]63,71,74,82,83,86,88,98], neurological diseases [29,35,37,39,41,44,62,65,77,81,82,84,97], rheumatic diseases [29,32,33,39,[41][42][43][44]47,55,[57][58][59][60]65,74,77,79,80,83,88,91,94,98], psychological/psychiatric conditions [27,32,38,42,45,46,49,50,55,[59][60][61]63,64,66,69,70,[73][74][75][79][80][81][82][83]89,91,94], intake medication [32,35,41,44,49,54,57,58,64,66,75,95], diabetes mellitus [32,43,44,55,57,58,65,85], cancer [32,34,46,58,64,67,82,89], skin disorders [29,[50][51][52]92], trauma [59-61, 65,83,92], hypertension [32,[42][43][44]57,58,65,66,72], migraine [59][60][61]83], osteoarthritis [30,43,66,85,91], peripheral nerve entrapment [59][60][61]83], obesity [29,39,74], substance abuse [64,73,77], and hypotension [50,51,65]. It is important to mention that in 54.7% (n = 40/73) of clinical trials, people with cardiac, pulmonary or kidney diseases were excluded since these "visceral" conditions could limit the therapeutic intervention used in these trials (exercise). ...
... The exclusion criteria were heterogeneous and included pregnancy [27,46,47,53,[59][60][61]63,71,74,82,83,86,88,98], neurological diseases [29,35,37,39,41,44,62,65,77,81,82,84,97], rheumatic diseases [29,32,33,39,[41][42][43][44]47,55,[57][58][59][60]65,74,77,79,80,83,88,91,94,98], psychological/psychiatric conditions [27,32,38,42,45,46,49,50,55,[59][60][61]63,64,66,69,70,[73][74][75][79][80][81][82][83]89,91,94], intake medication [32,35,41,44,49,54,57,58,64,66,75,95], diabetes mellitus [32,43,44,55,57,58,65,85], cancer [32,34,46,58,64,67,82,89], skin disorders [29,[50][51][52]92], trauma [59-61, 65,83,92], hypertension [32,[42][43][44]57,58,65,66,72], migraine [59][60][61]83], osteoarthritis [30,43,66,85,91], peripheral nerve entrapment [59][60][61]83], obesity [29,39,74], substance abuse [64,73,77], and hypotension [50,51,65]. It is important to mention that in 54.7% (n = 40/73) of clinical trials, people with cardiac, pulmonary or kidney diseases were excluded since these "visceral" conditions could limit the therapeutic intervention used in these trials (exercise). ...
Article
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Evidence supports the presence of comorbid conditions, e.g., irritable bowel syndrome (IBS), in individuals with fibromyalgia (FM). Physical therapy plays an essential role in the treatment of FM; however, it is not currently known whether the IBS comorbidity is considered in the selection criteria for clinical trials evaluating physiotherapy in FM. Thus, the aim of the review was to identify whether the presence of IBS was considered in the selection criteria for study subjects for those clinical trials that have been highly cited or published in the high-impact journals investigating the effects of physical therapy in FM. A literature search in the Web of Science database for clinical trials that were highly cited or published in high-impact journals, i.e., first second quartile (Q1) of any category of the Journal Citation Report (JCR), investigating the effects of physical therapy in FM was conducted. The methodological quality of the selected trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Authors, affiliations, number of citations, objectives, sex/gender, age, and eligibility criteria of each article were extracted and analyzed independently by two authors. From a total of the 412 identified articles, 20 and 61 clinical trials were included according to the citation criterion or JCR criterion, respectively. The PEDro score ranged from 2 to 8 (mean: 5.9, SD: 0.1). The comorbidity between FM and IBS was not considered within the eligibility criteria of the participants in any of the clinical trials. The improvement of the eligibility criteria is required in clinical trials on physical therapy that include FM patients to avoid selection bias.
... A total of 3,562 participants were included. Of these, 26 studies (1,649 participants) examined exercises for patients with fibromyalgia (Assis et al., 2006;Assumpção et al., 2018;Bircan et al., 2008;Bjersing et al., 2012;Calandre et al., 2009;Demir-Göçmen et al., 2013;Duruturk et al., 2015;Evcik et al., 2008;Fernandes et al., 2016;Gavi et al., 2014;Genc et al., 2015;Jentoft et al., 2001;Jones et al., 2002;Kayo et al., 2012;Mannerkorpi et al., 2010;McCain et al., 1988;Nørregaard et Rooks et al., 2007;van Santen et al., 2002;Sañudo et al., 2010;Schachter et al., 2003;Sevimli et al., 2015;Valim et al., 2003;Wang et al., 2018), two studies (326 participants) examined exercises for patients with CWAD (Seferiadis et al., 2016;Vikne et al., 2007) and 22 studies (1,587 participants) examined exercises for patients with CINP (Andersen et al., 2008;Bobos et al., 2016;Borisut et al., 2013;Cramer et al., 2013;Falla et al., 2006;Häkkinen et al., 2008;Izquierdo et al., 2016;Javanshir et al., 2015;Karlsson et al., 2014;Khan et al., 2014;Kietrys et al., 2007;Kim & Kwag, 2016;Lansinger et al., 2007Lansinger et al., , 2013Lauche et al., 2016;O'Leary et al., 2012;Rendant et al., 2011;Salo et al., 2010Salo et al., , 2012Senthil et al., 2016;von Trott et al., 2009;Ylinen et al., 2003). The results are presented by clinical condition. ...
... Patients with fibromyalgia had a mean age of 45.8 years, and only 36 patients (2.2%) were male. Aerobic exercise was tested in 28 treatment groups (Assis et al., 2006;Bircan et al., 2008;Bjersing et al., 2012;Duruturk et al., 2015;Fernandes et al., 2016;Genc et al., 2015;Jentoft et al., 2001;Kayo et al., 2012;Mannerkorpi et al., 2010;McCain et al., 1988;Nørregaard et al., 1997;Ramsay et al., 2000;Richards & Scott, 2002;van Santen et al., 2002;Sañudo et al., 2010;Schachter et al., 2003;Sevimli et al., 2015;Valim et al., 2003;Wang et al., 2018), including walking, exercise on a cycle ergometer/bicycle, exercise on a treadmill, land-based or water-based exercise or exercise with high and low intensity. Muscle strengthening was tested in five treatment groups (Assumpção et al., 2018;Bircan et al., 2008;Gavi et al., 2014;Jones et al., 2002;Kayo et al., 2012), stretching in eight (Assumpção et al., 2018;Calandre et al., 2009;Demir-Göçmen et al., 2013;Gavi et al., 2014;Genc et al., 2015;Jones et al., 2002;McCain et al., 1988;Valim et al., 2003), a combination of different types of exercise in nine (Demir-Göçmen et al., 2013;Evcik et al., 2008;Nørregaard et al., 1997;Richards & Scott, 2002;Rooks et al., 2007;Sañudo et al., 2010;Sevimli et al., 2015), Tai Chi in two (Calandre et al., 2009;Wang et al., 2018) and balance exercises in one treatment group (Duruturk et al., 2015). ...
... Twelve studies presented high risk of bias considering incomplete outcome data (eight in fibromyalgia (Assis et al., 2006;Calandre et al., 2009;Gavi et al., 2014;Jentoft et al., 2001;Nørregaard et al., 1997;van Santen et al., 2002;Schachter et al., 2003;Valim et al., 2003) and four in CINP (Andersen et al., 2008;Häkkinen et al., 2008;Lansinger et al., 2013;Salo et al., 2012)), because these studies had different dropout rates between groups, did not use intention-to-treat analysis, or used non-recommended imputation methods (Figure 3). The assessment of selective reporting bias was difficult because only one research protocol was available (Wang et al., 2015). ...
Article
Background and objective: To compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash-associated disorders (CWAD), and chronic idiopathic neck pain (CINP). Databases and data treatment: Randomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis. Results: Fifty studies with 3,562 participants were included. For fibromyalgia, both aerobic or strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50- to 60-minute supervised sessions, 2 to 3 times a week, for 13 weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90-minute supervised sessions, twice a week, for 10 to 16 weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30- to 60-minute supervised sessions, 2 to 3 times a week, for 7 to 12 weeks. Conclusions: The choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non-nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills.
... Water temperature also enhances physiological and sensory effects (Honda and Kamioka 2012;Macias-Hernandez et al. 2015). Hydrotherapy and aquatic exercise provide physiological benefits such as pain reduction through the blockage of nociceptive signals (Assis et al. 2006;Castro-Sanchez et al. 2012;Honda and Kamioka 2012); increased blood flow (Becker 2009;Honda and Kamioka 2012); muscle relaxation and reduced fatigue (Bidonde et al. 2014;Busch et al. 2011); reduced peripheral oedema, which may also assist in pain reduction (Gabrielsen et al. 2000;Honda and Kamioka 2012); reduced sympathetic nervous system (SNS) activity and orthostatic intolerance, and enhanced autonomic function (Becker 2009); and reduced mechanical loading on joints (Castro-Sanchez et al. 2012). Aquatic exercise may also enhance physical function (strength and aerobic capacity) (Assis et al. 2006;Becker 2009;Kanitz et al. 2015;Meredith-Jones et al. 2011). ...
... Hydrotherapy and aquatic exercise provide physiological benefits such as pain reduction through the blockage of nociceptive signals (Assis et al. 2006;Castro-Sanchez et al. 2012;Honda and Kamioka 2012); increased blood flow (Becker 2009;Honda and Kamioka 2012); muscle relaxation and reduced fatigue (Bidonde et al. 2014;Busch et al. 2011); reduced peripheral oedema, which may also assist in pain reduction (Gabrielsen et al. 2000;Honda and Kamioka 2012); reduced sympathetic nervous system (SNS) activity and orthostatic intolerance, and enhanced autonomic function (Becker 2009); and reduced mechanical loading on joints (Castro-Sanchez et al. 2012). Aquatic exercise may also enhance physical function (strength and aerobic capacity) (Assis et al. 2006;Becker 2009;Kanitz et al. 2015;Meredith-Jones et al. 2011). Increased aerobic capacity can be attributed to enhanced cardiac output and stroke volume, and lower heart rate (HR), as increased venous pressure and vasodilation force blood from lower extremities to the thoracic cavity and heart (Becker 2009;Torres-Ronda and del Alcazar 2014). ...
Article
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PurposeThis pilot pre-and post-intervention study investigated the effects of a short-term aquatic exercise programme on physiological outcomes, symptoms and exercise capacity in women with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Methods Eleven women (54.8 ± 12.4 year) volunteered for the 5-week program; an initial 20-min aquatic exercise session then two self-paced 20-min sessions per week for 4 weeks. Pre- and post-intervention outcomes were physiological measures, 6 min Walk Test (6MWT), perceived exertion (RPE), hand grip strength, Sit-to-Stand, Sit-Reach test, Apley’s shoulder test, FACIT questionnaire, and 24-h post-test tiredness and pain scores (0–10 visual analogue scale). Heart rates, RPE, 24- and 48-h post-session tiredness/pain scores were recorded each session. Results6MWT distance increased by 60.8 m (p = 0.006), left hand grip strength by 6 kg (p = 0.038), Sit-Reach test by 4.0 cm (p = 0.017), right shoulder flexibility by 2.9 cm (p = 0.026), FACIT scores by 8.2 (p = 0.041); 24-h post-test tiredness and pain decreased by 1.5 and 1.6, respectively (p = 0.002). There were significant post-intervention increases in exercising heart rates (6MWT 4- and 6-min time points), oxygen saturation at 2-min, and reduced RPE at 4-min. Weekly resting and exercising heart rates increased significantly during the study but RPE decreased; immediately post- and 24-h post-session tiredness decreased significantly. There were no reports of symptom exacerbation. Conclusions Five weeks of low-moderate intensity aquatic exercise significantly improved exercise capacity, RPE and fatigue. This exercise mode exercise may potentially be a manageable and safe physical activity for CFS/ME patients.
... Conditions like fibromyalgia, which is characterized by global muscle and joint pain, muscle pain, arthritis, and NP, have shown therapeutic analgesic effects to exercise. 6 Both human and animal models have validated these findings. Inhibitory neurotransmitters, such as serotonin and dopamine have been linked to an elevation postexercise sessions. ...
... Inhibitory neurotransmitters, such as serotonin and dopamine have been linked to an elevation postexercise sessions. [6][7][8] The exact mechanism of exercise-induced analgesia is poorly understood. Studies have shown that after aerobic exercise, there is an analgesic effect to thermal and mechanical stimuli. ...
Article
Aim This study aimed to evaluate the predictivity of exerciseinduced hypoalgesia (EIH) profile on pain severity produced by nerve injury in an animal model. Materials and methods A total of 51 rats were divided according to the EIH model, which was evaluated by the percentage of withdrawal actions of 30 repetitive physical stimuli on the hind paw of the rat before and after 3 minutes of exercise on a treadmill, into high and low EIH. Left infraorbital nerve injury was then done on rats from high and low EIH groups. Pain assays as mechanical allodynia and mechanical hyperalgesia were evaluated in the ipsilateral and unaffected whisker pad before and 3, 10, and 17 days after the surgery. Results Rats that were categorized as low EIH showed increased hypersensitivity and demonstrated significantly severe mechanical hyperalgesia in ipsilateral side 10 and 17 days after the surgery compared with the high EIH rats. Conclusion The authors concluded that the pinprick behavioral assay (mechanical hyperalgesia) was able to predict chronic pain development in the area of the trigeminal nerve distribution using EIH profile measured at the hind paw of the rat. How to cite this article Assiri K. Exercise-induced Hypoalgesia Profiles for Pain Prediction in the Trigeminal System. World J Dent 2017;8(1):21-27.
... Scientific evidence supports the use of physical exercise program for the overall management of this population group (Busch et al., 2008). Improvements have been reported among others in pain relief, sleep quality, stiffness, anxiety or depression (Assis et al., 2006;Bircan et al., 2008;Gusi et al., 2006;Tomas-Carus et al., 2005Valkeinen et al., 2008 . Despite this, the symptoms of FM often create obstacles that deter many from exercising consistently enough to derive benefits (Jones and Liptan, 2009). ...
... In the study by Gowans et al. (2004), no significant improvements were noted in depression and anxiety subscales of FIQ in patients receiving a 6-week aerobic exercise and educational program. Longer trials that used aerobic exercise (Assis et al., 2006) or a combination of exercise and education (Valim et al., 2003) found significant improvements in psychological status. However, the improvements in anxiety and depression showed in the current study let us to think that the intensity and duration selected may be enough to induce benefits in these patients psychological status. ...
... (20) La balneoterapia o terapia termale sono forme di idroterapia. Tutti gli studi analizzati riportano benefici riguardanti la riduzione del dolore e il miglioramento della qualità di vita (19,21,22,23). La balneoterapia agisce con diversi meccanismi. ...
... (26) Una comparazione tra l'esercizio di corsa in acqua profonda, rispetto agli esercizi "a secco" si è dimostrato efficace nella riduzione del dolore. (23) Anche gli esercizi personalizzati a resistenza progressiva migliorano l'intensità del dolore. (27) Lo studio di Torres dimostra come l'intensità del dolore migliora in un programma di mobilizzazione neurodinamica attiva, condotto per 2 volte alla settimana per 8 settimane consecutive. ...
Article
La fibromialgia (FM) è una sindrome complessa caratterizzata da dolore muscoloscheletrico diffuso cronico. Nonostante l’elevata incidenza, prevalentemente nella popolazione femminile, la diagnosi e la cura della fibromialgia risultano una sfida sia per il paziente che per l’operatore sanitario. Si tratta di una sindrome complessa e multifattoriale che necessita un approccio multidisciplinare. Questo lavoro esplora l’approccio bio-psico-sociale e comunicativo del fisioterapista esperto nel trattamento del dolore nei pazienti affetti da fibromialgia in accordo con le raccomandazioni ACR ed EULAR e la classificazione ICF. Il ruolo del fisioterapista è essenziale, in quanto - accanto alla terapia fisica e manuale – egli integra l’ascolto e la comprensione degli aspetti più profondi del dolore.
... Assis et al. [4] verglichen in einer randomisierten und kontrollierten klinischen Studie an 60 Fibromyalgie-Patienten im Alter von 18 bis 60 Jahren die Wirksamkeit eines Trainings im Wasser mit derjenigen eines Trainings an Land. Die Patienten führten die Übungen jeweils an der anaeroben Schwelle aus. ...
... Der Trainingseffekt war für beide Gruppen ähnlich gross. Die Wirksamkeit auf die emotionellen Aspekte wurde von den Autoren im Fall der Übungen im Wasser jedoch als überlegen bewertet [4]. In einer klinischen Studie an 61 Patienten waren die messbaren Effekte der von den Patienten zu Hause durchgeführten aeroben Übungen gleich gut wie die von unter Anleitung eines Physiotherapeuten durchgeführten hydrotherapeutischen Übungen (Verminderung der Schmerzen, Verbesserung der Stimmung, Verbesserung der Funktion). ...
... scored below two were excluded from the study. (Matsutani et al., 2007;Hasson et al., 2004;Ang et al., 2011;Gusi and Tomas-Carus, 2008;Mannerkorpi et al., 2009;Redondo et al., 2004;Ramsay et al., 2000;King et al., 2002;Ide et al., 2008;Da Costa et al., 2005;Cedraschi et al., 2004;Fontaine et al., 2010Fontaine et al., & 2011Gavi et al., 2014;Gowans et al., 2001;Arcos-Carmona et al., 2011;Assis et al., 2006;Bement et al., 2011;Bjersing et al., 2012;Bressan et al., 2008;Gusi et al., 2006;Hakkinen et al., 2001;Jentoft et al., 2001;Jones et al., 2002;Jones et al., 2008;Kaleth et al., 2013;Kingsley et al., 2005;Munguia-Izquierdo et al., 2008;Newcomb et al., 2011;Richards and Scott, 2002;Rooks et al., 2007;Sanudo et al., 2010;Schachter et al., 2003;Stephens et al., 2008;Tomas-Carus et al., 2007;Valim et al., 2013;Valkeinen et al., 2004;; Pharmacology was used in another 3 studies (Younger et al., 2009;Arnold et al., 2011;Chappell et al., 2008); cognitive behavioral therapy and other psychotherapy techniques were studied in 15 studies (Kashikar-Zuck et al., 2012;2013a, 2013bHamnes et al., 2012;Alda et al., 2011;Carleton and Richter, 2011;Koulil et al., 2010;Ang et al., 2013;Hsu et al., 2010;Luciano et al., 2014;Menga et al., 2014;Menzies et al., 2014;Sephton et al., 2007;Thieme et al., 2003); MFR techniques were reported in 2 studies (Castro-Sanchez et al., 2011a& 2011b; Multidisciplinary programme were reported in 5 studies (Castel et al., 2013;Clarke-Jenssen et al., 2014;Lemstra and Olszynski 2005;Martins et al., 2014;Bourgault et al., 2015), Acupuncture were studied in 7 studies (Itoh and Kitakoji, 2010;Hadianfard and Parizi, 2012;Harris et al., 2005;Harris et al., 2009;Martin et al., 2006;Stival et al., 2014;Targino et al., 2008) and the remaining 21 studies are reported on other treatment techniques like reiki, acupuncture, biofeedback, Qigong therapy, Soy supplement, Transcranial direct current stimulation, Craniosacral therapy, Guided imagery, Internet-enhanced management, whole-body vibration training, and laser (Assefi et al., 2005;Riberto et al., 2011;Wahner-Roedler et al., 2011;Lynch et al., 2012;Babu et al., 2007;Assefi et al., 2008;Gusi et al., 2010;Lofgren et al., 2009;Garza-Villarreal et al., 2014;Reis et al., 2014;Wang et al., 2010;Gamber et al., 2002;Letieri et al., 2013;Fioravanti et al., 2009;Almeida et al., 2003;Zijlstra et al., 2005). Discussion: the principal finding of this review is to document the available treatment approaches on the management of FM and to find out the gap in the literature for the future studies. ...
Article
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Background: Fibromyalgia (FM) is a common chronic musculoskeletal pain disorder, which has a negative effect on the quality of life. Patient often feel incapable of performing the basic daily life activities as walking, going up stairs, or lifting objects. The literature indicates the overall prevalence rate is about 2-6% worldwide. Patients with fibromyalgia go through various pharmacology and non-pharmacological treatments. The purpose of this systematic review is to provide an overview of research studies focused on the various treatment procedures and to find out the gap in the literature for the future studies in FM condition. Methods: Studies in any language were identified by searching through databases like MEDLINE, Google Scholar, and Science Direct and PEDro. Articles in which some form of treatment methods was used to manage fibromyalgia were included. The PRISMA guidelines for systematic reviews were followed. Results: Several researchers demonstrated the individual effects of their therapeutic techniques; a specific intervention will not work for every patient because each patient has a different constellation of symptoms resulting in different responses to therapeutic interventions. Conclusion: Our results suggested that the combination of soft tissue releases along with psychotherapy and medication is necessary to resolve the overall symptoms of fibromyalgia.
... Given that exercise in water heated to 33.5°C promotes increased cardiac output, blood metabolism, and the production of certain neurotransmitters like catecholamines and beta-endorphins, we hypothesized potential modifications to BDNF levels after the application of a controlled protocol of water exercises in people with FB (Assis et al. 2006). Thus, given the potential for significant changes to a patient's quality of life, better pain control, and a decrease in expenses due to a reduction in drug costs, the main objective of our study was to determine if BDNF levels changed after the practice of a specific aquatic physical therapy protocol during which pain and heart rate parameters were controlled. ...
Article
Objectives: This work aims to assess changes in brain-derived neurotrophic factor (BDNF) levels in women after the practice of a specific short duration 10-session aquatic physical therapy protocol in patients with fibromyalgia (FB). Methods: Case–control study. Thirteen women diagnosed with FB and 11 controls with the same age group, 35–55 years. Patients were evaluated according to the visual analog scale of pain and the fibromyalgia impact questionnaire (FIQ). All were subjected to a short protocol totaling 10 sessions of 40 min twice a week for five weeks. Heart rate and pain were monitored. BDNF levels were measured using enzyme immunoassay. Results: A statistically significant increase in BDNF values was noted in patients with FB between the pre- and post-10th session assessments (mean of 35.52–41.96; p = 0.041). Conclusion: BDNF values may present fluctuations during a short duration moderate aerobic exercise protocol, when measured and analyzed in a longitudinal design. Further studies with a more frequent BDNF evaluation could help in understanding its behavior more accurately and are warranted.
... La similitud en el instrumento no se encuentra en los resultados de los mismos, pues resultan bastante más dispares que en el resto de variables, porque, aunque en todos los estudios se observa una mejora, la magnitud de ésta no es la misma según la fuente consultada. Así, ordenando de manera decreciente el valor del mismo encontamos una reducción de este síntoma con los siguientes valores: 41,5 (el presente estudio), 36 (33), 34,19 (27), 14,5 (34), 8,7 (35), 8,5 (28), 7,4 (31), 3,11(30) y 3 (36). ...
Article
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Background: The number of people suffering from chronic diseases increases with the population ageing. The therapeutic benefits from Physical Therapeutic Program (PTP) on chronic pathologies favoured the integration of such exercises in physical activities. The purpose of this study was to examine through a quantitative and qualitative assessment the PTP implementation within a community. Participants and method: 92 participants were asked to perform the PTP three times a week in an appropriate group according to his/her needs. Results: After a Therapeutic Aquatic Activity (TAA) significant pre-post test differences were found on VAS questionnaire and at Physio-Pilates (PP) PCS12_SP, VAS_EQ VAS and post-intervention with a confidence level of 95% making the T-Student, while using the Wilcoxon test differences were found in the RMQ, EQ5D_ET and MCS12_SP in AAT, and RMQ in PP questionnaires.
... O critério de diagnóstico é determinado por dor generalizada em pelo menos 4 a 5 pontos, acima de 3 meses, com índice de dor generalizada maior ou igual a 7 e escala de sintomas de severidade maior ou igual a 5 [4]. Existem várias formasde tratamento dentre elas o treinamento aeróbico, sendo o mais indicado, melhorando a oxigenação tecidual e aumentando a resistência muscular [5]. O meio aquático tem alto potencial para a reabilitação de patologias agudas e/ou crônicas, mas continua sendo um meio não muito explorado. ...
... Assis et al. 14 compararam um programa de exercícios físicos de caminhada na água em piscina aquecida com um programa de caminhada/ corrida no solo em 60 pacientes, com idades entre 18 e 60 anos. Ao final do estudo, ocorreu a diminuição da dor relacionada à FM. ...
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Objectives: To investigate in the literature about the effects of the physical exercise in fibromyalgia (FM), being analyzed the variables pain, depression and quality of life. Methods: We conducted a search in the SciELO, Medline and PubMed indexes with keywords "fibromyalgia and exercise", in articles published in the last 20 years from January 1991 to February 2011. Results: Regarding the effect on pain, both aerobic activities and the muscular endurance exercises showed beneficial effects in the fibromyalgia. Regarding the effect on depression levels, the studied exercises (QiGong, aerobic exercises, and strength exercise) showed favorable to decrease. In relation to the effect on quality of life, also occurred improvement of this variable with aerobic exercises, strength and flexibility, showing positive effects for patients with fibromyalgia. Conclusion: Exercise helps in the treatment of fibromyalgia, influencing in a positive way reducing pain, depression and improving quality of life in this population.
... 9 Evidence for the effectiveness of aquatic exercise has been reported in patients with rheumatic disease, fibromyalgia, stroke, Parkinson disease, and so on. [10][11][12][13] Furthermore, there have been reports that use of aquatic therapy can improve dynamic balance and gait speed in adults with neurological conditions. 14 Aquatic exercise is beneficial for improving neuromuscular function of the patients with neurologic disorders due to the advantages of the physical characteristics of water, including natural buoyancy, hydrostatic pressure, thermodynamics, hydrodynamic forces, and viscosity. ...
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Objective: Low back pain is the most common musculoskeletal condition with a high prevalence. There was no sufficient evidence to recommend that aquatic exercise was potentially beneficial to patients with low back pain. The aim of this study was to systematically analyze all evidence available in the literature about effectiveness of the aquatic exercise. Design: A comprehensive search of PubMed, the Cochrane Library, Embase, and Cumulative Index to Nursing and Allied Health was conducted from their inceptions to November 2016 for randomized controlled trials, which concerned the therapeutic aquatic exercise for low back pain. The results were expressed in terms of standardized mean difference and the corresponding 95% confidence interval. Results: Eight trials involving 331 patients were included in the meta-analysis, and the results showed a relief of pain (standardized mean difference = -0.65, 95% confidence interval = -1.16 to -0.14) and physical function (standardized mean difference = 0.63, 95% confidence interval = 0.17 to 1.09) after aquatic exercise. However, there was no significant effectiveness with regard to general mental health in aquatic group (standardized mean difference = 0.46; 95% confidence interval = -0.22 to 1.15). Conclusions: Aquatic exercise can statistically significantly reduce pain and increase physical function in patients with low back pain. Further high-quality investigations on a larger scale are required to confirm the results.
... 4,10,14,15,27 It has been reported that predominantly aerobic APT associated with the advantages brought about by the physical properties of water (i.e., drag, thrust) and medium temperature effectively contribute to increase aerobic functional capacity. 4,10,28 In addition to the above factors, it could be inferred that the standardization of the effort intensity using as main reference HR obtained at VAT was efficient to improve aerobic functional capacity of women with FMS. This aspect of the present 13 study must be emphasized, since most studies that have proposed APT for patients with FMS did not standardize physical training nor controlled effort intensity. ...
Article
Background: Aquatic physical training (APT) has been strongly recommended to improve symptoms in fibromyalgia syndrome (FMS). However, its effects on body composition and whether lean body mass (LBM) directly influences the aerobic functional capacity of this population are still not clear. Aim: To investigate whether APT can help improve body composition and increase the aerobic functional capacity in women with FMS, and whether oxygen consumption (VO2) related to LBM can better quantify the functional capacity of this population. Design: Randomized controlled trial. Setting: The Federal University of São Carlos, São Paulo, Brazil. Population: Fifty-four women with FMS were randomly assigned to trained group (TG=27) or control group (CG=27). Methods: All women underwent cardiopulmonary exercise test (CPET) to assess oxygen consumption at ventilatory anaerobic threshold (VAT) and at peak exercise, and also to assess body composition. The TG was submitted to APT program, held twice a week for 16 weeks. The exercise intensity was adapted throughout the sessions in order to keep heart rate and ratings of perceived exertion achieved at VAT. Results: After APT, body composition was not significantly different between groups (TG and CG). In VAT only TG showed increased VO2 related to LBM, since in peak cardiopulmonary exercise test, VO2 in absolute units, VO2 related to total body mass (TBM), VO2 related to LBM and power showed significant differences. Significant difference between VO2 related to TBM and VO2 related to baseline LBM and after 16 weeks of follow-up, both in VAT as in peak CPET in both groups. Significant difference between VO2 related to TBM and VO2 related to LBM at VAT and at peak CPET in both groups at baseline and after 16 weeks of follow-up was observed. Conclusions: APT with standardized intensities did not cause significant changes in body composition, but was effective in promoting increased VO2 at peak CPET in women with FMS. However, VO2 related to LBM more accurately reflected changes in aerobic functional capacity at VAT level after to APT. Clinical rehabilitation impact: APT with standardized intensities at VAT level is of great interest, since VAT reflects better aerobic functional capacity of patients with FMS than maximum VO2.
... In addition to supervision, the only study in SLE that improved cardiorespiratory fitness used the HR training corresponding to the ventilatory anaerobic threshold during the whole exercise program [7]. The same method of prescription was used for patients with fibromyalgia also with an improvement in cardiorespiratory fitness [44,45]. Lemos et al. [32] have demonstrated that the percentage of the exercise prescription in the anaerobic threshold intensity for sedentary women with fibromyalgia syndrome must be from 75 to 80% of the HR max reached in the treadmill test. ...
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Objective The aim of this study was to evaluate the safety and effectiveness of a supervised walking program in women with primary Sjögren’s syndrome (pSS). Methods Forty-five sedentary women fulfilling the American European Consensus Criteria for pSS were randomized to a training group (TG, n = 23) or control group (CG, n = 22). Patients in the TG were submitted to supervise walking three times a week for 16 weeks. The patients of the CG were instructed to not perform any kind of regular physical exercise. Physical fitness [maximum oxygen uptake (VO2max) and distance], EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), hematological tests, and Medical Outcomes Study 36 (SF-36) were assessed at baseline and week 16. In addition, EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-fatigue), and Beck Depression Inventory (BDI) were measured prior to intervention, after 8 and 16 weeks. Patient global assessment of response to therapy was completed at the final assessment. An intent-to-treat analysis was performed. Results After 16 weeks, the mean change of VO2max (ml/kg/min), distance, and FACIT-fatigue were higher in the TG than in the CG (p = 0.016, p = 0.043 and p = 0.030, respectively). Improved cardiorespiratory fitness was associated with improvements in fatigue scores and physical components of quality of life (SF-36). Furthermore, improved fatigue scores were associated with reduced depression and improvements in the physical and mental components of SF-36. Overall, 95.4% of patients in the TG rated themselves as clinically improved versus 62% of the patients in the CG (p = 0.049). There was no flare in disease activity and no serious adverse events with exercise. Conclusions This supervised walking program was demonstrated to be feasible and safe with improvements in cardiorespiratory fitness, exercise tolerance, fatigue, and patient perception of improvement in pSS patients. Trial registration Clinical Trials.gov ID, number NCT02370225.
... The effectiveness of DWR as an alternative to other aerobic workouts has also been demonstrated at different ages: among young persons and middle-aged (Nakanishi et al 1999) and older persons (Broman et al 2006). Additionally, it is clinically effective in various musculoskeletal disorders with a mechanical impact, such as hip and knee osteoarthritis (Hinman et al 2007) and fibromyalgia (Assis et al 2006). ...
Article
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Objectives: To evaluate clinical effect of deep water running(DW R) on non-specific low back pain. Outcome measures were pain, disability,general health and physical fitness. Materials and methods: Experimental, randomized, controlled trial involving 46 persons with CLBP over 15 weekswith two experimental processes, each three times a week. Evidence-basedProgram (EBP, personalized physical exercise program, manual therapy andhealth educa tion) was the common process to which was added 20 minutes ofpersonalized intensity DW R at the aerobic threshold. Measurements were made at the beginning and end of the studyof pain, disability, general health and physical fitness. R esults: The pain of CLBP were homogeneous at baseline.Significant changes between group were don’t found for pain in favour of the EBP+DW R group (p<0.3). The within-group differences were highly significant for all clinical and functional variables. The effect was clinically relevant forpain in the EBP+DW R group (0.70) and in the EBP group (0.58), and for disability degree it was also relevant in theEBP+DW R group (0.48) and relevant for the EBP group (0.36). Conclusion: Significant improvement was seen inCLBP when EBP was complemented with the high-intensity exercise of DW R.
... The content of the NE session is listed in Appendix 1.The NE was accompanied by the use of pictures, examples, and metaphors (Butler and Moseley, 2003; Moseley, 2007). The initial session (examination and NE) was subsequently followed by a series of seven physical therapy visits, which included additional NE and other treatment strategies that have been reported to improve outcomes in patients with chronic pain, such as aquatic therapy (Assis et al, 2006 ), cardiovascular exercise (Bonifazi et al, 2006; Brosseau et al, 2008a; Busch et al, 2007; Carville et al, 2008; Goldenberg, Burckhardt, and Crofford, 2004; Gowans et al, 2001; Rooks et al, 2007; Sim and Adams, 2002), and strengthening (Brosseau et al, 2008b; Valkeinen et al, 2005). The therapeutic activities are listed in Table 2 . ...
... 144 A noncontrolled study comparing water-based exercise with landbased exercise showed an average 36% reduction in pain. 145 Exclusions in this study included 67 for work schedule incompatibility and 32 for nonspecified refusals; 60 patients were randomly assigned, and 52 completed the study. ...
... Biodance involves the movement accompanied by music, inducing experiences capable of modifying the organism at the physiological, affective, motor, and existential levels [19]. Aquatic Biodance adds the benefits of water-based exercise programs [20,21]. Belly Dance is an ancient form of dance which may promote physical rehabilitation, relaxation, social support, and bodymind connection [22]. ...
Article
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Objective The aim of this study was to perform a systematic review on the effectiveness of dance-based programs in patients with fibromyalgia, as well as calculate the overall effect size of the improvements, through a meta-analysis. Methods The Cochrane Library, Physiotherapy Evidence Database (PEDro), PubMed, TRIP, and Web of Science (WOS) were selected to identify the articles included in this systematic review and meta-analysis. A total of seven articles fulfilled all inclusion and exclusion criteria. PRISMA guidelines were followed in the data extraction process. The level of evidence was established following guidelines from the Dutch Institute for Healthcare Improvement (CBO). Results The studies were all randomized controlled trials, but not double-blind. Duration of dance programs ranged from 12 to 24 weeks. Sessions lasted between 60 and 120 minutes and were performed 1-2 times per week. The overall effect size for pain was -1.64 with a 95% CI from -2.69 to -0.59 which can be interpreted as large. In addition, significant improvements were observed in quality of life, depression, impact of the disease, anxiety, and physical function. Conclusion Dance-based intervention programs can be an effective intervention for people suffering from fibromyalgia, leading to a significant reduction of the level of pain with an effect size that can be considered as large. However, findings and conclusions from this meta-analysis must be taken with caution due to the small number of articles and the large heterogeneity.
... Wśród osób niewyćwiczonych trening z wykorzystaniem DWR okazał się równie skuteczny jak bieganie na bieżni oraz połączenie DWR i bieżni do zwiększenia maksymalnego poboru tlenu (18). DWR okazało się również skuteczne do poprawy maksymalnego i szczytowego poboru tlenu w grupie osób starszych (19), otyłych kobiet (20), jak również kobiet z fibromialgią (21). ...
Article
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Streszczenie: Uzyskanie odpowiedniego poziomu wytrzymałości jest kluczowe w wielu programach rehabilitacyjnych oraz treningowych. Środowisko wodne poprzez swoje właściwości daje możliwość wykorzystania wielu form treningu wytrzymałościowego w zależności od potrzeb lub ograniczeń. Szczególnie we wczesnej rehabilitacji lub na etapie powrotu do treningu sportowego może być jedyną możliwością podtrzymywania lub zwiększania sprawności układu sercowo-naczyniowego. Do najczęściej stosowanych form należy bieganie w wodzie głębokiej. Najłatwiejszym sposobem monitorowania intensywności wysiłku w wodzie jest rejestracja częstości skurczów serca, jak również użycie skali Borga. Należy jednak pamiętać o tym, że wartości częstości skurczów serca będą niższe niż na lądzie. Badania pokazują również, że niejednokrotnie przy mniejszym obciążeniu na stawy możemy uzyskać wyniki porównywalne do treningu na lądzie. Słowa kluczowe: trening w wodzie, zdolności motoryczne, bieg w wodzie głębokiej Summary: Achieving an optimal level of endurance is a key factor in many rehabilitation and training programs. Unique properties of aquatic environment enable to use many forms of training in order to maintain or improve cardiorespiratory fitness, especially at the early stage of rehabilitation or return to training. Deep water running is the most often used form of training. The easiest way of monitoring the intensity of endurance training in water is the use of heart rate or rate of perceived exertion. However, we need to remember that heart rate values will be lower than on land. Research also shows that, with less joint impact, we can achieve results comparable to land training.
... Both studies used a visual analog scale (graded from 0-10) and reported similar results. For example, Assis et al. (2006) reported no significant difference in pain levels between aquatic and land-based groups with an average decrease in pain of 36% for both groups. Melton-Rogers et al. (1996) reported no difference in pain levels between aquatic and land-based groups when measured at peak VO 2 and at 60% of peak VO 2 . ...
Article
Four of the most popular modes of aquatic exercise are deep water (DW) exercise, shallow water (SW) exercise, water calisthenics (WC), and underwater treadmill (UT) exercise. The mechanical requirements of each aquatic exercise mode may elicit different physiological and biomechanical responses. The purpose of this descriptive literature review was to evaluate some biophysical differences between aquatic and land-based exercises. The biophysical variables reviewed included oxygen consumption (VO 2), heart rate (HR), rating of perceived exertion (RPE), stride length, stride frequency, pain, and measures of functional gain. Based on the studies reviewed, when compared with similar land-based exercises, VO 2 and HR maximum values were lower during DW and SW exercise, but, depending on water depth and exercise performed, may be greater during WC and UT exercise. RPE during DW exercise was generally similar to land exercise during max effort. Stride frequency tended to be lower for all four aquatic exercises, relative to onland counterparts. Pain levels tended to be similar between WC and land exercise, yet may decrease after UT exercise.
... Our hypothesis is that the mat Pilates method can bring more benefits to improve the disease-related symptoms than that of aquatic aerobic exercise. We chose aquatic aerobic exercise for the purpose of comparison in knowing that aquatic aerobic exercise is a strongly recommended modality as a non-pharmacological treatment for people with fibromyalgia [26]; moreover, we believe that this type of exercise can be considered more fun, providing greater adherence to treatment and few studies have used aquatic aerobic exercises to compare with other exercise modalities in treating fibromyalgia. ...
Article
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Background: The mat Pilates method is the therapeutic modalities which can be used in fibromyalgia treatment. Although there are no well-designed studies that prove the effectiveness of the mat Pilates method in this population. The objective was to evaluate the effectiveness of the mat Pilates method for improving symptoms in women with fibromyalgia. Methods: A single blind randomized controlled trial in which 42 women with fibromyalgia were randomized into two groups: mat Pilates and aquatic aerobic exercise. The exercises were performed twice a week for 12 weeks. Two evaluations were performed: one at baseline (T0), and another at 12 weeks after randomization (T12). The primary outcome was pain measured by the Visual Analogue Scale (VAS). Secondary outcomes were function (Fibromyalgia Impact Questionnaire), sleep (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Short Form 36 [SF-36]), fear avoidance (Fear Avoidance Beliefs Questionnaire [FABQ-BR]) and pain catastrophizing (Pain-Related Catastrophizing Thoughts Scale [PRCTS]). Results: There was improvement in both groups in relation to pain and function (p < 0.05). The aspects related to quality of life and the FABQ questionnaire only showed improvement in the mat Pilates group (p < 0.05). There was improvement in the PSQI and PRCTS variables only in the aquatic aerobic exercise group (p < 0.05), but no differences were observed between the groups for any of the evaluated variables. Conclusion: Significant improvements were observed in the two groups in relation to the disease symptoms, and no differences were observed between mat Pilates and aquatic aerobic exercise in any of the measured variables. Trial registration: ClinicalTrials.gov Identifier (NCT03149198), May 11, 2017. Approved by the Ethics Committee of FACISA/UFRN (Number: 2.116.314).
... Balancing exercises were also performed in the sitting and standing positions with floating plates [8,26,27] and Ai-chi movements with exercises in unipodal or bipodal support according to the participant's tolerance [18,28]. Cooling down included gait exercises with waist dissociation, standing-balancing with Ai-chi upper limb movements (first five movements), followed by relaxing cervical movements, shoulder rotations, and slow stretches [29][30][31][32][33][34]. ...
Article
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Background: Aquatic physiotherapy has been shown to be effective in developing balance, strength, and functional reach over time. When dealing with immediate effects, the literature has concentrated more on the body's physiological response to the physical and mechanical properties of water during passive immersion. The purpose of this study was to evaluate the effects of a single 45-min active aquatic physiotherapy session on standing balance and strength, and its relationship with functional reach in persons 55 years and older with upper limb dysfunction. Methods: The intervention group (n = 12) was assessed before and after a single aquatic physiotherapy session, while the control group (n = 10) was evaluated before and after 45 min of sitting rest. Functional assessment was made using the visual analogue pain scale (points), step test (repetitions), functional reach test (cm), and global balance-standing test on a force platform (% time). A two-way repeated-measures ANOVA was applied (p < 0.05). Results: The intervention group showed non-significant improvements between measurement before and after the intervention: Pain: 6.2 ± 1.9 vs. 5.2 ± 2.3 cm, steps: 7.0 ± 2.0 vs. 7.4 ± 1.8 repetitions, reach: 9.1 ± 2.8 vs. 10.4 ± 3.8 cm, and balance: 61.7 ± 5.9 vs. 71.3 ± 18.2% time in balance on the platform. The control group showed fewer changes but had better baseline values. A comparison between groups with time showed no significant differences in these changes. Conclusions: No significant immediate effects were found for one session of aquatic physiotherapy applied to patients older than 55 years with upper limb dysfunction.
... 26 With regard to aquatic aerobic exercises, a meta-analysis 27 found good results for aquatic therapy (hydrotherapy) with a duration of over 20 weeks; however, in our study, we will use aquatic exercises with an aerobic purpose, rather than just aquatic physiotherapy. Deep water running is an aquatic aerobic conditioning technique that has shown to be as beneficial as aerobic exercise on land, however with advantages related to emotional aspects in women with FM. 28 A systematic review carried out by Bidonde et al 11 concluded that low to moderate quality of evidence in relation to the control suggests that aquatic training is beneficial in improving the well-being, symptoms and fitness in adults with FM. Low-quality evidence suggests that aquatic and land exercises have benefits, except for muscle strength (low-quality evidence favouring land exercises), and also that no serious adverse effects were found. ...
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Introduction Physical exercises have been recommended to improve the overall well-being of patients with fibromyalgia, with the main objective of repairing the effects of lack of physical conditioning and of improving the symptoms, especially pain and fatigue. Although widely recommended and widely known, few studies support the use of Pilates as an effective method in improving the symptoms of the disease, comparing it with other well-founded exercise modalities. This protocol was developed to describe the design of a randomised controlled study with a blind evaluator that evaluates the effectiveness of mat Pilates, comparing it with aquatic aerobic exercises, in improving pain in women with fibromyalgia. Methods Sixty women aged 18–60 years with a diagnosis of fibromyalgia, with a score of between 3 and 8 points on the Visual Analogue Scale for pain, and who sign the clear and informed consent form will be recruited according to the inclusion criteria. They will be randomised into one of the two intervention groups: (1) Pilates, to perform an exercise programme based on mat Pilates; and (2) aquatic exercise, to participate in a programme of aerobic exercises in the swimming pool. The protocol will correspond to 12 weeks of treatment, with both groups performing the exercises with supervision twice a week. The primary outcome will be pain (Visual Analogue Scale for pain). The secondary outcomes are to include impact related to the disease, functional capacity, sleep quality and overall quality of life. The evaluations will be performed at three points: at baseline and after 6 weeks and 12 weeks of treatment. Ethics and dissemination This protocol has been approved by the Ethics Committee of FACISA/UFRN (number: 2.116.314). Data collection will begin after approval by the ethics committee. There will be prior contact with the women, at which time all the information about the study and the objectives will be presented, as well as resolution no 466/2012 of the National Health Council of Brazil for the year 2012, which provides guidelines and regulatory standards for research involving human beings. Participants must sign the informed consent form before the study begins. Trial registration number NCT03149198 .
... Aquatic therapy was found to be a pain relief treatment among people with fibromyalgia (Assis et al., 2006), multiple sclerosis (Castro-Sanchez et al., 2012) and neurologic or musculoskeletal disease (Hall et al., 2008). However, so far, there is no data from clinical trials or real life concerning the effect of aquatic therapy on pain among children with profound intellectual and multiple disabilities. ...
... For example, previous research on aquatic interventions describes the numerous physical benefits such as decreased pain (Baena-Beato et al., 2014;Cantarero-Villanueva et al., 2012), bone loss prevention (Tsukahara et al., 1994), improved functional and motor performance (Fragala-Pinkham et al., 2014;Hillier et al., 2010;Salem & Jaffee Gropack, 2010), increased strength (Kargarfard et al., 2013;Chi et al., 2011), increased endurance (Routi et al., 1994), improved fitness (Wang et al., 2007;Driver et al., 2004), and improved pulmonary function (Ferreira et al., 2013;Getz, et al., 2006). Furthermore, aquatic therapy has been shown to have a number of psychological benefits including improved body image (Smith & Michel, 2006), decreased depression (Benedict & Freedman, 1993), enhanced mood (Assiss et al., 2006), decreased anxiety (Rogers et al., 2014), and improved quality of life (Lai et al., 2014;Maniu et al. 2013). The use of aquatics as a treatment modality dates to ancient times with the Greeks, Romans, Egyptians, Hindus, Japanese, and Chinese all having recordings of using water for therapeutic purposes (Broach, 2016). ...
Article
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Aquatic therapy interventions are critical for individuals with disabilities and the role of the therapist is just as critical for successful and effective interventions. The field of therapeutic recreation trains students to develop and implement evidence-based facilitation techniques including the use of aquatic therapy to assist in helping clients achieve a change in functional status. This review of the literature examined the impact of aquatic therapy interventions on a variety of disabilities including osteoarthritis, multiple sclerosis, Cerebral palsy, autism spectrum disorder, and mental health from a recreational therapy (RT) perspective. This review provides a variety of information on the positive benefits that may occur using aquatic therapy for diverse conditions. Examples include relaxation, stretching, and aerobic exercise and each has the ability to improve strength. It does appear that aquatic therapy interventions can provide a wide array of benefits that may reduce the burden associated with a variety of disabilities. These benefits may be useful in increasing the overall quality of life of a diverse group of disabilities. Likewise, due to the nature of RT, recreational therapists are in a unique position to provide plan and develop aquatic therapy interventions. However, it is the authors’ suggestion that those providing this service attend intensive training in order to provide aquatic therapy effectively. Additional research may be necessary to provide a more cohesive understanding of the impact of aquatic therapy on a variety of populations. Nonetheless, the information gleamed from this review, justify that aquatic therapy has benefits for a diverse clientele and thus may be useful in the implementation of RT programs.
... Grade A outcomes were found for pain relief (190,(197)(198)(199), psychological well-being (200), endurance (200), anxiety (200), self efficacy (200), depression (201), quality of life (190,165,198,199,202), muscle strength (force-generating capacity) (197), cardiorespiratory fitness (190,198,199), physical general awareness (198), and flexibility (190). However, applying the Jadad scale only, 6 out of the 16 trials were of high methodological quality (≥ 3), (188,197,199,(203)(204)(205) with scores ranging from 3 to 5. ...
Article
Fibromyalgia is a condition which appears to involve disordered central afferent processing. The major symptoms of fibromyalgia include multifocal pain, fatigue, sleep disturbances, and cognitive or memory problems. Other symptoms may include psychological distress, impaired functioning, and sexual dysfunction. The pathophysiology of fibromyalgia remains uncertain but is believed to be largely central in nature. In 1990 the American College of Rheumatology (ACR) published diagnostic research criteria for fibromyalgia. The criteria included a history of chronic and widespread pain and the presence of 11 or more out of 18 tender points. Pain was considered chronic widespread when all of the following are present: pain in the left side of the body; pain in the right side of the body; pain above the waist; pain below the waist. In addition, axial skeletal pain must be present and the duration of pain must be more than 3 months. A tender point is considered positive when pain can be elicited by pressures of 4 kg/ cm2 or less. For tender points to be considered positive, the patient must perceive the palpation as painful; tenderness to palpation is not sufficient. However, over the next 20 years it became increasingly appreciated that the focus on tender points was not justified. In 2010 a similar group of investigators performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop new preliminary ACR diagnostic criteria, and to construct a symptom severity (SS) scale. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, un-refreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. The investigators combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI ≥ 7 AND SS ≥ 5). Although there is no known cure for fibromyalgia, multidisciplinary team efforts using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy, and pharmacologic therapies (serotonin norepinephrine reuptake inhibitors [e.g., duloxetine, milnacipran] and alpha 2-delta receptor ligands [e.g., pregabalin]) might improve symptoms as well as function in patients with fibromyalgia. Key Words: Pain, fibromyalgia, fatigue, sleep, duloxetine, pregabalin, milnacipran
... Water running is a wide spread aerobic training method causing less stress to muscle-skeletal apparatus or impaired structure than running on dry land. This exercise method was developed in the USA by Marines' Track and Field trainer Glenn Mc Water and worldwide used as an effective training alternative in endurance athletes [1][2][3], or to improve cardiovascular fitness in sedentary [4] as well as for prevention [5] and rehabilitation [6][7][8]. ...
... Individuals in the galvanic group experienced greater improvements in terms of decreased pain, increased perception of energy, and enhanced physical or psychological well-being. Our study results are in accordance with previous studies, which proved greater improvements in SF-36 domains and physical and mental health improvements following strength and aerobic exercise interventions for patients with FM [38][39][40]. The greater improvements in SF-36 scores that we observed in individuals who were assigned to the galvanic group might have been influenced by the greater improvements due to the buoyancy and hydrostatic pressure effects of water in hydrogalvanic bath therapy compared to the control group. ...
Article
Purpose Although a number of treatments are widely prescribed for fibromyalgia (FM), many are not fully effective. In clinical practice, the effectiveness of electrotherapy is limited in particular to hydro-galvanic bath therapy in the management of FM. This experiment aims to evaluate whether hydro-galvanic bath therapy can be beneficial in decreasing pain and increasing quality of life for individuals with FM. Material and Methods This quasi-experimental study recruited 92 individuals diagnosed with FM who were then divided equally either into a galvanic group or control group. The galvanic group received both hydro-galvanic bath therapy and a 12-week supervised aerobic exercise program, whereas the control group only received the exercise program. Outcomes were assessed at baseline and post-intervention using the Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), SF-36 Health Survey, and Visual Analog Scale (VAS). Results and discussion Individuals in both groups showed excellent compliance with interventions by attending more than 85% of sessions. Both groups showed a significant change in all outcome measures evaluated (p<0.001), but the galvanic group showed greater improvements when compared with the control group (p<0.001). The galvanic group showed a 16.6% of FIQ score, 8.2% of SF-36 score, 25.0% of BDI score, and 53.2% of VAS score from baseline. In turn, the control group demonstrated a reduction of 6.8% of FIQ score, 11.8% of SF-36 score, 22.0% of BDI score, and 41.6% of VAS score. Conclusion The galvanic group who received galvanic bath therapy along with aerobic exercise for 12 weeks evoked greater change in FIQ, BDI, and SF-36 Health Survey scores compared with results of aerobic exercise alone in control group.
... Non-pharmacological therapies have been recommenced for the management of FM. For example, exercise is strongly recommended as it promotes improvements in pain [12][13][14][15]. In his sense, low to moderate-intensity aerobic exercises are recommended [16] and moderateintensity aerobic exercise is reported to reduce the systemic concentration of biomarkers indicative of stress (e.g., cortisol and noradrenaline) and inflammation (e.g. ...
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The objective of this study was to verify the effects of aerobic exercise associated with tryptophan (TRP) supplementation on hyperalgesia, as well as on cortisol, IL-6 and TNF concentrations in female rats with experimental fibromyalgia (FM). Female Wistar rats (initial body weight: ~ 350 g; age: 12 months) were randomly divided into 5 groups: CON (Control); F (Fibromyalgia induced); FE (Fibromyalgia induced plus exercise); FES (Fibromyalgia induced plus exercise and TRP supplementation) and FS (Fibromyalgia induced plus TRP supplementation). Fibromyalgia was induced with two injections (20 μL) of acidic saline (pH 4.0) into the right gastrocnemius muscle with a 3-day interval. Control animals received the same doses of neutral saline (pH 7.4). The exercised animals underwent progressive low-intensity aerobic exercise (LIAE) on a treadmill (10–12 m/min, 30–45 min/day, 5 days/week) for three weeks. During this period, the supplemented animals received a TRP supplemented diet (210 g/week), while the others received a control diet. Mechanical hyperalgesia was evaluated weekly and serum cortisol and muscle IL-6 and TNF concentrations were assessed after three weeks of interventions. Experimental FM caused bilateral hind paw hyperalgesia and augmented serum cortisol and muscle IL-6 concentrations. After 3 weeks of interventions, LIAE alone reduced hyperalgesia (151%) and reduced serum cortisol concentrations (72%). Tryptophan supplementation itself diminished hyperalgesia (57%) and reduced serum cortisol concentrations (67%). Adding TRP supplementation to LIAE did not further reduce hyperalgesia significantly (11%), which was followed by an important decrease in muscle IL-6 concentrations (68%), though reduction in serum cortisol pulled back to 45%. Muscle TNF concentrations were not affected. In conclusion, the association of TRP supplementation to LIAE does not potentiate significantly the reduction of bilateral mechanical hyperalgesia promoted by LIAE in female rats with experimental FM, however an important decrease in IL-6 is evident.
... However, the mean value at the end of the treatment was higher than 8 points, considered the marked score for the diagnosis of psychological distress [45]. These results are similar to previous studies showing that aerobic exercise reduces pain intensity, mechanical pain sensitivity, and psychological distress [16,[46][47][48][49], however, in this clinical trial, we achieved improvements with a TP without face-to-face sessions. ...
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Background: We analyzed the immediate effects of a Telerehabilitation Program (TP) based on aerobic exercise in women with fibromyalgia (FM) syndrome during the lockdown declared in Spain due to the COVID-19 pandemic. Methods: A single-blind randomized controlled trial was designed. Thirty-four women with FM were randomized into two groups: TP group and Control group. The intervention lasted 15 weeks, with 2 sessions per week. The TP based on aerobic exercise was guided by video and the intensity of each session was monitored using the Borg scale. Pain intensity (Visual Analogue Scale), mechanical pain sensitivity (algometer), number of tender points, FM impact (Revised Fibromyalgia Impact Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), physiological distress (Hospital Anxiety and Depression Scale), upper (Arm Curl Test) and lower-limb physical function (6-min Walk Test) were measured at baseline and after the intervention. Results: The TP group improved pain intensity (p = 0.022), mechanical pain sensitivity (p < 0.05), and psychological distress (p = 0.005), compared to the Control group. The Control group showed no statistically significant changes in any variable (p > 0.05). Conclusions: A TP based on aerobic exercise achieved improvements on pain intensity, mechanical pain sensitivity, and psychological distress compared to a Control group during the lockdown declared in Spain due to COVID-19 pandemic.
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Objective: to evaluate the effect of swimming on pain, functional capacity, aerobic capacity and quality of life on patients with fibromyalgia (FM). Design: Randomized controlled trial (RCT). Setting: Rheumatology outpatient clinics of a university hospital. Participants: Seventy-five female patients, aged 18 to 60 years, with FM randomly assigned to a swimming group (SG; n = 39) or a walking group (WG; n = 36). Intervention: The SG performed 50 minutes of swimming 3 times a week for 12 weeks, with a heart rate at 11 beats under the anaerobic threshold (AT). The WG performed walking with heart rate at the AT, with the same duration and frequency of SG. Main outcome measures: Participants were evaluated prior to the exercise protocols (T0), at six weeks (T6) and at 12 (T12) weeks after the onset of the protocols. The primary outcome measure was VAS for pain. The secondary measurements were: Fibromyalgia Impact Questionnaire and SF-36 questionnaire for quality of life; spiroergometric test for cardiorespiratory variables; and Timed Up-and-Go Test for functional performance. Results: Patients in both groups experienced improvement in pain after the 12-week program, however with no difference between groups (p= 0,658). The same results were found regarding functional capacity and quality of life. Moreover, no statistical difference between groups was found regarding aerobic capacity over time. Conclusion: Swimming, like walking, is an effective method for reducing pain and improving both functional capacity and quality of life in patients with FM.
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The objective of our nonrandomised controlled study was to evaluate the effect of a 4-week aerobic exercise program on muscle performance in patients with fibromyalgia. Thirty-two women were consecutively divided into two groups, either study or control group. Study group attended at aerobic exercise program on treadmill lasting 30 minutes, five times a week for four weeks. Electrotherapy and thermotherapy also were applied to back region of patients in study group for two weeks. Control group were treated only the same electrotherapy and thermotherapy interventions lasted 30 minutes, five times a week for two weeks. All patients were assessed before and after treatment protocols with respect to pain, fatigue, fibromyalgia-related symptoms, tender point count/ score, psychological status and muscle strengths of knee extensors and flexors. There were statistically significant improvements in the intensity of pain, fatigue, percentage of morning stiffness, paresthesia, irritable bowel syndrome, tender point count/score, psychological status and muscle strengths after aerobic exercise program. However, there were significant improvements only in the intensity of pain, percentage of paresthesia, tender point count/score in the control group. Submaximal aerobic walking program increased muscle performance in addition to positive effects on pain, fatigue, fibromyalgia-related symptoms and psychological status in patients with fibromyalgia.
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Objectives: To compare the effects of water exercise and land exercise on balance, quality of life and depression in postmenopausal women with osteoporosis. Design: Prospective study Setting: Tertiary level of care, 1 center participated in the study. Participants: Sixty postmenopausal women with osteoporosis were consecutively selected from patients of Osteoporosis Outpatient Clinic. Interventions: They performed either water exercise (WE) or land exercise (LE). WE group (n=30) received a 3-week water exercise program. LE group (n=30) received a 3-week home exercise program. Main outcome measures: Balance, quality of life and depression level were evaluated using step test, Short Form 36 (SF-36) questionnaire and Beck Depression Inventory (BDI), respectively. Results: In WE group, there were significant improvements in step test on both sides after exercise and on the right side 2 months after exercise. In WE group, there were significant increases in all domains of SF-36 questionnaire after exercise and in five domains 2 months after exercise. In WE group, the rate of the patients whose depression level became normal were greater than those in LE group after exercise and 2 months after exercise. In LE group, there were no significant improvements in step test on both sides after exercise and 2 months after exercise. In LE group, only physical function domain of SF-36 increased significantly after exercise. Conclusions: Water exercise rather than land exercise is more effective in improving balance, quality of life and depression in postmenopausal women with osteoporosis.
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Background: Fibromyalgia is a chronic condition characterized by generalized pain. Several studies have been conducted to assess the effects of non-pharmacological conservative therapies in fibromyalgia. Objective: To systematically review the effects of non-pharmacological conservative therapies in fibromyalgia patients. Methods: We searched MEDLINE, Cochrane library, Scopus and PEDro databases for randomized clinical trials related to non-pharmacological conservative therapies in adults with fibromyalgia. The PEDro scale was used for the methodological quality assessment. High-quality trials with a minimum score of 7 out of 10 were included. Outcome measures were pain intensity, pressure pain threshold, physical function, disability, sleep, fatigue and psychological distress. Results: Forty-six studies met the inclusion criteria. There was strong evidence about the next aspects. Combined exercise, aquatic exercise and other active therapies improved pain intensity, disability and physical function in the short term. Multimodal therapies reduced pain intensity in the short term, as well as disability in the short, medium and long term. Manual therapy, needling therapies and patient education provided benefits in the short term. Conclusions: Strong evidence showed positive effects of non-pharmacological conservative therapies in the short term in fibromyalgia patients. Multimodal conservative therapies also could provide benefits in the medium and long term.
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Fibromyalgia syndrome (FMS) is a multisystem disorder, characterized by widespread pain that is usually associated with hyperalgesia and allodynia. Comorbidities such as fatigue, stiffness, insomnia, depression and anxiety make its classification and treatment difficult. The confluence of pain and other symptoms and conditions such as fatigue, depression, sleep disturbance and cognitive dysfunction contribute to the reduced function and quality of life in patients with FMS. Clinical trials have shown that optimum benefit may be obtained only with therapeutic strategies including both pharmacological and non-pharmacological interventions taking into consideration pain severity, symptoms and functional status. The aim of this review was to summarize the current literature on pharmacological and non-pharmacological treatments of FMS as well as to evaluate the evidence of the value of the available treatment interventions. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing.
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Fibromyalgia describes a diverse symptom complex, including widespread body pain, tenderness to palpation, and somatic complaints. Fibromyalgia affects approximately 2% of adults, with women affected six times more frequently than men. Prevalence increases with age. Patients with fibromyalgia report significant disability, psychological distress, and reduced physical and mental health and quality of life. Most patients with fibromyalgia report reduced pain and medication use over a 3-year period. Fibromyalgia is best treated with multidisciplinary treatment, using therapies to specifically target symptoms of individual patients.
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Underwater exercise programs are among the nursing programs for which positive effects have been reported with regard to the promotion of good health in diverse subjects, such as patients suffering arthritis, as well as elderly people and middle-aged women. Through many previously conducted studies, subjects participating in underwater exercises have been reported to continuously experience reduced pain, and improvement in muscle strength, flexibility, sense of balance, and muscular endurance. However, few studies have delved into the fundamental phenomena of positive effects of underwater exercises on the human body. In this study, a model of the upper limbs of the human body was used in a simulation of underwater exercises to analyse the resulting pressure fluctuation on the skin of the hands and arms of the model through the methods of computational fluid dynamics. During the simulation of underwater exercises, pressure fluctuation of diverse frequencies, arising from the vortex flow around the articulations of the fingers and hands of the model, were identified and were seen to create varied cutaneous stimulations and massage effects. Such cutaneous stimulations seem to continuously excite capillary vessels situated between hands and finger joints, creating positive effects in blood circulation around pain sites of patients suffering from arthritis.
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A standardized fitness assessment is critical for the development of an individualized exercise prescription. Although the benefits of aquatic exercise have been well established, there remains the need for a standardized nonswimming protocol to accurately assess cardiorespiratory fitness (CRF) in shallow water. The present investigation was designed to assess (a) the reliability of a standardized shallow water run (SWR) test of CRF and (b) the accuracy of a standardized SWR compared with a land-based treadmill (LTM) test. Twenty-three healthy women (20 ± 3 years), with body mass index (23.5 ± 3 kg·m), performed 2 shallow water peak oxygen consumption (V[Combining Dot Above]O2peak) running tests (SWRa and SWRb), and 1 V[Combining Dot Above]O2max LTM. Intraclass correlation coefficients indicated moderately strong reliability for V[Combining Dot Above]O2peak (ml·kg·min) (r = 0.73, p < 0.01), HRpeak (b·min) (r = 0.82; p < 0.01), and O2pulse (V[Combining Dot Above]O2 [ml·kg·min]·HR [b·min]) (r = 0.77, p < 0.01). Using paired t-tests and Pearson's correlations, SWR V[Combining Dot Above]O2peak and HRpeak were significantly lower than during LTM (p ≤ 0.05) and showed moderate correlations of 0.60 and 0.58 (p < 0.001) to LTM. O2pulse was similar (p > 0.05) for the SWR and LTM tests with a moderate correlation of 0.63. A standardized SWR test as a measure of CRF is a reliable, and to some degree, valid alternative to conventional protocols and may be used by strength and conditioning professionals to measure program outcomes and monitor training progress. Furthermore, this protocol provides a water-based option for CRF assessment among healthy women and offers insight toward the development of an effective protocol that can accommodate individuals with limited mobility, or those seeking less musculoskeletal impact from traditional land-based types of training.
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Introduction Fibromyalgia (FM) is consistently associated with fatigue, sleep disturbances, morning stiffness, and anxiety and depression, affecting physical capacities and skills and thereby reducing quality of life. The aim of this study was to compare the effects of water‐based and land‐based therapies as an adjuvant treatment for women with FM in relation to quality of life and physical aspects. Methods FM women were randomized into a water‐based exercise group (WG) and land‐based exercise group (LG). The interventions were conducted for 8 weeks, three times a week, and each therapy session had a 60‐min duration. Evaluations were performed before and after intervention using the Fibromyalgia Impact Questionnaire, the Visual Analogue Scale, the number of tender points (TPs), and the Wells bench sit and reach test score. Results Both interventions produced significantly positive clinical effects in most aspects evaluated. However, only WG obtained significant improvements for the variables functional capacity, number of TPs, and flexibility. Conclusions The findings suggest that water‐based exercise is effective as an adjuvant FM treatment, including FM‐related physical and psychological health aspects.
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Objective: The purpose of this review is to determine which exercise is the best to reduce the symptomatology of fibromyalgia. Search Strategy: Intervention studies in fibromyalgia were retrieved through searches in the main health-science databases: PEDro, PubMed, Cochrane Plus, ISI (Web of Knowledge), y PsycINFO, and in in publications of the field, Fisioterapia y Cuestiones de Fisioterapia, between March and October 2013. Results: After applying inclusion and exclusion criteria, and analyze the level of evidence, 32 publications were accepted in this review, classified in 5 different categories, depending on the type of activity. They were all randomized clinical trials. Conclusions: Exercise is effective for reducing symptomatology of fibromyalgia. Aquatic and combined exercise, and alternative activities seem to be more accurate in the treatment of tender points, depression, and they have higher levels of adherence. Relating to the rest of the symptoms, every other type of exercise has similar results. © 2017, Universidad Autonoma de Madrid y CV Ciencias del Deporte. All rights reserved.
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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.
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Background: Exercise training is commonly recommended for adults with fibromyalgia. We defined whole body vibration (WBV) exercise as use of a vertical or rotary oscillating platform as an exercise stimulus while the individual engages in sustained static positioning or dynamic movements. The individual stands on the platform, and oscillations result in vibrations transmitted to the subject through the legs. This review is one of a series of reviews that replaces the first review published in 2002. Objectives: To evaluate benefits and harms of WBV exercise training in adults with fibromyalgia. Search methods: We searched the Cochrane Library, MEDLINE, Embase, CINAHL, PEDro, Thesis and Dissertation Abstracts, AMED, WHO ICTRP, and ClinicalTrials.gov up to December 2016, unrestricted by language, to identify potentially relevant trials. Selection criteria: We included randomized controlled trials (RCTs) in adults with the diagnosis of fibromyalgia based on published criteria including a WBV intervention versus control 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 risk of bias assessments, and assessed the quality of evidence for major outcomes using the GRADE approach. We used a 15% threshold for calculation of clinically relevant differences. Main results: We included four studies involving 150 middle-aged female participants from one country. Two studies had two treatment arms (71 participants) that compared WBV plus mixed exercise plus relaxation versus mixed exercise plus relaxation and placebo WBV versus control, and WBV plus mixed exercise versus mixed exercise and control; two studies had three treatment arms (79 participants) that compared WBV plus mixed exercise versus control and mixed relaxation placebo WBV. We judged the overall risk of bias as low for selection (random sequence generation), detection (objectively measured outcomes), attrition, and other biases; as unclear for selection bias (allocation concealment); and as high for performance, detection (self-report outcomes), and selective reporting biases.The WBV versus control comparison reported on three major outcomes assessed at 12 weeks post intervention based on the Fibromyalgia Impact Questionnaire (FIQ) (0 to 100 scale, lower score is better). Results for HRQL in the control group at end of treatment (59.13) showed a mean difference (MD) of -3.73 (95% confidence interval [CI] -10.81 to 3.35) for absolute HRQL, or improvement of 4% (11% better to 3% worse) and relative improvement of 6.7% (19.6% better to 6.1% worse). Results for withdrawals indicate that 14 per 100 and 10 per 100 in the intervention and control groups, respectively, withdrew from the intervention (RR 1.43, 95% CI 0.27 to 7.67; absolute change 4%, 95% CI 16% fewer to 24% more; relative change 43% more, 95% CI 73% fewer to 667% more). The only adverse event reported was acute pain in the legs, for which one participant dropped out of the program. We judged the quality of evidence for all outcomes as very low. This study did not measure pain intensity, fatigue, stiffness, or physical function. No outcomes in this comparison met the 15% threshold for clinical relevance.The WBV plus mixed exercise (aerobic, strength, flexibility, and relaxation) versus control study (N = 21) evaluated symptoms at six weeks post intervention using the FIQ. Results for HRQL at end of treatment (59.64) showed an MD of -16.02 (95% CI -31.57 to -0.47) for absolute HRQL, with improvement of 16% (0.5% to 32%) and relative change in HRQL of 24% (0.7% to 47%). Data showed a pain intensity MD of -28.22 (95% CI -43.26 to -13.18) for an absolute difference of 28% (13% to 43%) and a relative change of 39% improvement (18% to 60%); as well as a fatigue MD of -33 (95% CI -49 to -16) for an absolute difference of 33% (16% to 49%) and relative difference of 47% (95% CI 23% to 60%); and a stiffness MD of -26.27 (95% CI -42.96 to -9.58) for an absolute difference of 26% (10% to 43%) and a relative difference of 36.5% (23% to 60%). All-cause withdrawals occurred in 8 per 100 and 33 per 100 withdrawals in the intervention and control groups, respectively (two studies, N = 46; RR 0.25, 95% CI 0.06 to 1.12) for an absolute risk difference of 24% (3% to 51%). One participant exhibited a mild anxiety attack at the first session of WBV. No studies in this comparison reported on physical function. Several outcomes (based on the findings of one study) in this comparison met the 15% threshold for clinical relevance: HRQL, pain intensity, fatigue, and stiffness, which improved by 16%, 39%, 46%, and 36%, respectively. We found evidence of very low quality for all outcomes.The WBV plus mixed exercise versus other exercise provided very low quality evidence for all outcomes. Investigators evaluated outcomes on a 0 to 100 scale (lower score is better) for pain intensity (one study, N = 23; MD -16.36, 95% CI -29.49 to -3.23), HRQL (two studies, N = 49; MD -6.67, 95% CI -14.65 to 1.31), fatigue (one study, N = 23; MD -14.41, 95% CI -29.47 to 0.65), stiffness (one study, N = 23; MD -12.72, 95% CI -26.90 to 1.46), and all-cause withdrawal (three studies, N = 77; RR 0.72, 95% CI -0.17 to 3.11). Adverse events reported for the three studies included one anxiety attack at the first session of WBV and one dropout from the comparison group ("other exercise group") due to an injury that was not related to the program. No studies reported on physical function. Authors' conclusions: Whether WBV or WBV in addition to mixed exercise is superior to control or another intervention for women with fibromyalgia remains uncertain. The quality of evidence is very low owing to imprecision (few study participants and wide confidence intervals) and issues related to risk of bias. These trials did not measure major outcomes such as pain intensity, stiffness, fatigue, and physical function. Overall, studies were few and were very small, which prevented meaningful estimates of harms and definitive conclusions about WBV safety.
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Antonio Roberto Zamunér,1 Carolina Pieroni Andrade,2 Eduardo Aguilar Arca,3 Mariana Arias Avila41Departamento de Kinesiología, Universidad Católica del Maule, Talca, Maule, Chile; 2Secretaria de Saúde do Município de Guareí, Guareí, São Paulo, Brasil; 3Departamento de Fisioterapia, Universidade do Sagrado Coração, Bauru, São Paulo, Brasil; 4Departamento de Fisioterapia e Programa de Pós-Graduação em Fisioterapia, Universidade Federal de São Carlos, São Carlos, São Paulo, BrasilAbstract: Exercise-related interventions have been recommended as one of the main components in the management of fibromyalgia syndrome (FMS). Water therapy, which combines water’s physical properties and exercise benefits, has proven effective in improving the clinical symptoms of FMS, especially pain, considered the hallmark of this syndrome. However, to our knowledge, the mechanisms underlying water therapy effects on pain are still scarcely explored in the literature. Therefore, this narrative review aimed to present the current perspectives on water therapy and the physiological basis for the mechanisms supporting its use for pain management in patients with FMS. Furthermore, the effects of water therapy on the musculoskeletal, neuromuscular, cardiovascular, respiratory, and neuroendocrine systems and inflammation are also addressed. Taking into account the aspects reviewed herein, water therapy is recommended as a nonpharmacologic therapeutic approach in the management of FMS patients, improving pain, fatigue, and quality of life. Future studies should focus on clarifying whether mechanisms and long-lasting effects are superior to other types of nonpharmacological interventions, as well as the economic and societal impacts that this intervention may present.Keywords: hydrotherapy, exercise, pain management, chronic pain, physical therapy, aquatic therapy
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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.
Article
Background: This study aimed to evaluate the therapeutic validity of exercise interventions included in a previous umbrella systematic review of high-quality randomized controlled trials (RCTs) in the management of fibromyalgia and to explore whether exercise interventions with high therapeutic validity and that meet the 2013 American College of Sports Medicine (ACSM) guidelines are positively associated with greater pain relief. Methods: Therapeutic validity was evaluated based on the CONsensus on Therapeutic Exercise and Training (CONTENT) Scale, in high methodological quality RCTs found in the nine systematic reviews of a previous umbrella review on exercise interventions in the management of fibromyalgia. Additionally, adherence to the 2013 ACSM exercise recommendations for fibromyalgia was analyzed. The effect size for pain relief after the exercise programs was also considered. Results: The CONTENT mean total score was 4.42 out of 9, demonstrating generally low therapeutic validity of the 28 included RCTs. There was poor concordance between therapeutic validity and pain relief (Kappa values ranging between -0.6 to 0.57). Kappa statistic results showed poor concordance (k=0.01) between statistically significant (P<0.05) pain relief values and adherence to the 2013 ACSM exercise recommendations. Conclusions: The therapeutic validity of exercise intervention programs in fibromyalgia is low. This is mainly due to incomplete descriptions of exercise interventions and adherence. Poor concordance is found between high therapeutic validity and adherence to the ACSM exercise recommendations with pain relief. Improved standardized reporting is recommended to identify optimal exercise prescription for fibromyalgia.
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Objective: To evaluate the effects of pool-based exercises on pain symptomatology among adults with fibromyalgia syndrome. Methods: A systematic review and meta-analysis were carried out using PRISMA guidelines. Database search was conducted by two independent reviewers. For meta-analysis, the visual analogue scale (VAS) score for pain was used as the primary outcome and the Fibromyalgia Impact Questionnaire (FIQ) score was utilized as the secondary outcome. Results: A total of 42 out of 292 potentially eligible studies were selected for being read in full by reviewers, 14 of which were included in meta-analysis, being 10 of them used in sensitivity analysis of either the primary or secondary outcome. Data pooled from 10 randomized controlled trials (n = 508) revealed that patients who underwent pool-based exercises exhibited a significantly lower mean in VAS score as compared to controls (SMD = -0.27, 95% CI: -0.45 to -0.09). Regarding FIQ scores, data from 10 randomized controlled trials were pooled (n = 578) and a lower mean score was also shown in the group that underwent a pool-based exercise program (SMD = -0.29, 95% CI: -0.49 to -0.09). Limitations of this study include the small sample size and moderate dropout rates in currently available clinical trials. Conclusion: Pool-based exercise may provide some additional benefit for pain relief in adults with fibromyalgia as compared to either land-based or no physical exercise. Implications of key findings: Collectively, these findings suggest that pool-based exercise deserves further attention as a potential adjuvant therapeutic option for adults with fibromyalgia. PROSPERO registration number: CRD42019136755.
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Objectives: The aims of this study were to translate into Brazilian- Portuguese, to cross-culturally adapt, and to evaluate the reliability and validity of the SF-36 in patients with rheumatoid arthritis (RA). Methods: The questionnaire was translated into Portuguese, translated back into English, and cross-culturally adapted to the Brazilian environment according internationally recommended methods. The SF-36 was administered by interview to 50 patients (7 male) with RA. To evaluate reliability, patients were interviewed twice at baseline (interviewers 1 and 2) and within a period of 15 days (interviewer 1). Several clinical and laboratory outcome measures were simultaneously assessed. The Nottingham Health Profile (NHP), Arthritis Impact Measurement Scales 2 (AIMS2), and HAQ were also administered. Descriptive statistics was used to characterize the patients. Pearson's correlation coefficient was used to evaluate reliability and validity. Results: Only 2 questions were modified in the cross-cultural adaptation phase. Mean (SD) age and disease duration of the patients were 49.2 (13.28) and 8.54 (6.55) years, respectively. Dimensions with the lowest mean scores reported in patients with RA were limitations due to physical abilities (59.50), physical functioning (63.96), and pain (66.50). The intra and inter observer reliability were statistically significant (0.4426 < r < 0.8468 and 0.5542 < r < 0.8101), respectively. For similar dimension scales, the correlation between SF-36 and HAQ, NHP, and AIMS2 were statistically significant (p < 0.01). Conclusions: The Brazilian-Portuguese version of the SF-36 is a reliable and valid quality of life measure for use in RA, supporting its use as an adjunct outcome measure for clinical trials in RA.
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A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
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ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d·wk-1, at less than 40-50% of V˙O2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations. In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.
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During a period of 20 weeks 18 female patients with fibromyalgia participated in a 60-minute exercise program twice a week. A control group, comprising 17 patients, was told not to change their physical activity level. Eleven patients in the training group and fourteen in the control group completed the study. The results at entry were compared to those after 20 weeks, as well as being compared to the results of the control group. No statistically significant changes or differences in general pain, pain coping and fatigue were seen after 20 weeks. Improved dynamic endurance work performance for the upper extremity was found, however, in the training group, measured as the strength of the first (p = 0.01) and the last repetition (p = 0.003). These results differed from the results of the control group (p = 0.02 and p = 0.003). It is concluded that fibromyalgia patients may undergo low-intensity dynamic endurance training without experiencing exacerbation of their general pain and fatigue symptoms.
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The effect of water immersion on cardiorespiratory and blood lactate responses during running was investigated. Wearing a buoyant vest, 10 trained runners (mean age 26 yr) ran in water at four different and specified submaximal loads (target heart rates 115, 130, 145, and 155-160 beats.min-1) and at maximal exercise intensity. Oxygen uptakes (VO2), heart rates, perceived exertion, and blood lactate concentrations were measured. Values were compared with levels obtained during treadmill running. For a given VO2, heart rate was 8-11 beats.min-1 lower during water running than during treadmill running, irrespective of exercise intensity. Both the maximal oxygen uptake (4.03 vs 4.60 1 x min-1) and heart rate (172 vs 188 beats.min-1) were lower during water running. Perceived exertion (legs and breathing) and the respiratory exchange ratio (RER) were higher during submaximal water running than during treadmill running, while ventilation (1 x min-1) was similar. The blood lactate concentrations were consistently higher in water than on the treadmill, both when related to VO2 and to %VO2max. Partly in conformity with earlier cycle ergometer studies, these data suggest that immersion induces acute cardiac adjustments that extend up to the maximal exercise level. Furthermore, both the external hydrostatic load and an altered running technique may add to an increased anaerobic metabolism during supported water running.
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A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
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An instrument has been developed to assess the current health status of women with the fibromyalgia syndrome. The Fibromyalgia Impact Questionnaire (FIQ) is a brief 10-item, self-administered instrument that measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. We describe its development and validation. This initial assessment indicates that the FIQ has sufficient evidence of reliability and validity to warrant further testing in both research and clinical situations.
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To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
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To examine whether general feelings of fatigue, exercise-induced pain in the extremities, and exertion were different in female patients with fibromyalgia syndrome (FS) compared with sedentary healthy women. Thirty-seven FS patients and 20 healthy subjects were studied. Cardiovascular fitness was assessed by Aastrand's indirect, submaximal method. The period of repetitive dynamic muscle contractions and sustained static muscle contraction were measured. General feelings of fatigue before exercise and exercise-induced extremity pain were assessed by visual analogue scales. Exercise-induced exertion was recorded by Borg's Rating Scale of Perceived Exertion. No significant group difference in cardiovascular fitness was found (p = 0.8). In the FS patients general fatigue was (median 95% confidence interval) 69 (59 - 75) versus 32 (22 - 47) for the healthy controls (p < 0.0001). At the moment of interrupting the bicycle test, the perceived exertion score was 17 (16 - 18) among patients versus 13 (13 - 15) among controls (p < 0.0001). Compared with the controls, high exercise-induced extremity pain was found after sustained static and repetitive dynamic muscle contractions in the FS patients (p < 0.004), and 24 hours later the patients' pain intensities had not returned to pre-exercise values (p < 0.01). High general fatigue, exercise-induced extremity pain, exertion and 24 hours post-exercise extremity pain in FS patients compared with healthy controls could not be explained by any group difference in cardiovascular fitness.
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The aim of this study was to examine physical performance in women with fibromyalgia (FM) using methods that are easy to use in clinical settings and to compare our findings with published norms or a healthy comparison group. Measures of shoulder pain and range-of-motion, isometric shoulder endurance, neck rotation, leg strength, hand grip strength, back flexibility, 6-minute walk distance, and symptom duration were completed on 97 subjects with FM. The comparison group was 30 age-matched healthy women. The FM group had significantly lower physical functioning scores on all variables when compared to the healthy group or published norms. When pain at rest was controlled, pain on motion was the most significant predictor of variance in shoulder range of motion, whereas range of motion was the most significant predictor of right shoulder endurance and grip strength of both hands. Women with FM are markedly below average in physical performance abilities when measured by clinical tests.
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To determine the effectiveness of self-management education and physical training in decreasing fibromyalgia (FMS) symptoms and increasing physical and psychological well being. A pretest-posttest control group design was used. Ninety-nine women with FMS were randomly assigned to 1 of 3 groups; 86 completed the study. The education only group received a 6-week self-management course. The education plus physical training group received the course and 6 h of training designed to assist them to exercise independently. The control group got treatment after 3 months. The experimental programs had a significant positive impact on quality of life and self-efficacy. Helplessness, number of days feeling bad, physical dysfunction, and pain in the tender points decreased significantly in one or both of the treated groups when retested 6 weeks after the end of the program. Longterm followup of 67 treated subjects showed significant positive changes on the Fibromyalgia Impact Questionnaire primarily in the physical training group. Among all subjects, 87% were exercising at least 3 times/week for 20 min or more; 46% said they had increased their exercise level since participating in the program; 70% were practicing relaxation strategies as needed; 46% were working at least half time as opposed to 37% at pretest. Self-efficacy of the treated groups was enhanced significantly by the program. Other changes were smaller and more delayed than had been expected. Recommendations for future trials include a longer education program, more vigorous physical training, and longterm followup.
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The purpose of this study was to evaluate the effect of aerobic walking on the pain, disability, and psychological symptoms of individuals with fibromyalgia. Nineteen subjects with fibromyalgia (2 men, 17 women), aged 30 to 69 years (mean = 49.35, SD = 11.83), participated. Ten subjects walked 20 minutes, three times per week, for 8 weeks at 60% to 70% of the predicted maximum heart rate for their age. Nine subjects served as sedentary controls. Each subject completed pretests and posttests of the McGill Pain Questionnaire (MPQ), the Sickness Impact Profile (SIP), and the Brief Symptom Inventory (BSI). Due to initial differences on all measures, final scores were adjusted and analyzed by an analysis of covariance. The experimental group had lower scores on the MPQ on two of the three BSI indexes, and on the Psychosocial Dimension scale of the SIP, but higher ratings on the Physical Dimension scale of the SIP than did the control group on final testing. Only the differences on one index of the BSI and the Physical Dimension scale of the SIP were significant. The results of the study are inconclusive. There were trends suggestive of a beneficial response to aerobic walking (lower psychological and pain ratings) but limited significant findings and higher physical disability ratings, for these individuals with fibromyalgia.
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We have validated a Portuguese version of the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) tests by obtaining profiles for three Brazilian samples: 270 university students, 117 panic patients and 30 depressed patients. The mean BDI scores were higher for depressed patients (25.2 +/- 12.6), intermediate for anxious patients (15.8 +/- 10.3) and lower for students (8.5 +/- 7.0). Mean STAI scores for anxious (52.8 +/- 11.4) and depressed patients (56.4 +/- 10.5) were higher than for the student sample (40.7 +/- 8.6). BDI and STAI scores were correlated significantly in all samples. The internal consistency of the Portuguese version of BDI is in agreement with the literature (0.81 for students and 0.88 for depressed patients). The present data demonstrate that the psychometric properties of the Portuguese versions of the BDI and STAI are comparable to the original English language versions of these questionnaires, thereby indicating their use in clinical situations.
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Running in water has the potential to decrease the compressive forces on the spine as the body is supported. The aim of the study was to determine the magnitude of this loss in stature compared with running on land. Fourteen runners completed three 30 minute runs on separate days in deep water, shallow water, and on a motor driven treadmill. During the three conditions, runners exercised at 80% of their exercise mode specific peak oxygen consumption. Subjects rested in the Fowler position for 20 minutes before and after exercise. Measurements of changes in stature were taken before resting, before running, after 15 minutes of running, after 30 minutes of running, and after the post-exercise rest in the Fowler position. Changes in stature were recorded using a stadiometer accurate to 0.01 mm. Loss of stature values were 4.59 (1.48), 5.51 (2.18), and 2.92 (1.7) mm (means (SD)) for running on the treadmill, and in shallow and deep water respectively. Running in deep water caused significantly lower creep than in the other trials (p<0.05), with no difference between the shallow water and treadmill conditions. Loss of stature was greater in the first half of the run for all conditions (p<0.05). Ratings of perceived exertion did not differ between the three exercise conditions. Results support the use of deep water running for decreasing the compressive load on the spine.
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To determine the accumulated 24-hour cardiovascular autonomic modulation and its circadian variations in patients with fibromyalgia, by means of heart rate variability analysis. Thirty patients with fibromyalgia and 30 age- and sex-matched controls were studied prospectively. Assessments included a 24-hour ambulatory recording of heart rate variability, time-domain analysis of the accumulated 24-hour R-R interval variations, and power spectral analysis to determine the sympatho/ vagal balance at different hours (calculated as the power spectral density of the low-frequency [0.04-0.15-Hz] sympathetic band divided by the power of the high-frequency [0.15-0.50-Hz] parasympathetic band). Fibromyalgia patients had diminished accumulated 24-hour heart rate variability, manifested by a decreased standard deviation of all R-R intervals (mean +/- SD 126 +/- 35 ms, versus 150 +/- 33 ms in controls; P = 0.008) and a decreased ratio of pairs of adjacent R-R intervals differing by >50 ms (mean +/- SD 12.0 +/- 9.0% versus 20.1 +/- 18.0%; P = 0.031). Patients lost the circadian variations of sympatho/vagal balance, with nocturnal values significantly higher than those of controls at time 0 (mean +/- SD 3.5 +/- 3.2 versus 1.2 +/- 1.0; P = 0.027) and at 3 hours (3.3 +/- 3.0 versus 1.6 +/- 1.4; P = 0.01). Individuals with fibromyalgia have diminished 24-hour heart rate variability due to an increased nocturnal predominance of the low-frequency band oscillations consistent with an exaggerated sympathetic modulation of the sinus node. This abnormal chronobiology could explain the sleep disturbances and fatigue that occur in this syndrome. Spectral analysis of heart rate variability may be a useful test to identify fibromyalgia patients who have dysautonomia.
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To evaluate the effects of 6 months of pool exercise combined with a 6 session education program for patients with fibromyalgia syndrome (FM). The study population comprised 58 patients, randomized to a treatment or a control group. Patients were instructed to match the pool exercises to their threshold of pain and fatigue. The education focused on strategies for coping with symptoms and encouragement of physical activity. The primary outcome measurements were the total score of the Fibromyalgia Impact Questionnaire (FIQ) and the 6 min walk test, recorded at study start and after 6 mo. Several other tests and instruments assessing functional limitations, severity of symptoms, disabilities, and quality of life were also applied. Significant differences between the treatment group and the control group were found for the FIQ total score (p = 0.017) and the 6 min walk test (p < 0.0001). Significant differences were also found for physical function, grip strength, pain severity, social functioning, psychological distress, and quality of life. The results suggest that a 6 month program of exercises in a temperate pool combined with education will improve the consequences of FM.
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To examine the effects of pool-based (PE) and land-based (LE) exercise programs on patients with fibromyalgia. The outcomes were assessed by the Fibromyalgia Impact Questionnaire, the Arthritis Self-Efficacy Scale, and tests of physical capacity. Eighteen subjects in the PE group and 16 in the LE group performed a structured exercise program. After 20 weeks, greater improvement in grip strength was seen in the LE group compared with the PE group (P < 0.05). Statistically significant improvements were seen in both groups in cardiovascular capacity, walking time, and daytime fatigue. In the PE group improvements were also found in number of days of feeling good, self-reported physical impairment, pain, anxiety, and depression. The results were mainly unchanged at 6 months followup. Physical capacity can be increased by exercise, even when the exercise is performed in a warm-water pool. PE programs may have some additional effects on symptoms.
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To evaluate cardiovascular fitness exercise in people with fibromyalgia. Randomised controlled trial. Setting: Hospital rheumatology outpatients. Group based classes took place at a "healthy living centre." 132 patients with fibromyalgia. Prescribed graded aerobic exercise (active treatment) and relaxation and flexibility (control treatment). Participants' self assessment of improvement, tender point count, impact of condition measured by fibromyalgia impact questionnaire, and short form McGill pain questionnaire. Compared with relaxation exercise led to significantly more participants rating themselves as much or very much better at three months: 24/69 (35%) v 12/67 (18%), P=0.03. Benefits were maintained or improved at one year follow up when fewer participants in the exercise group fulfilled the criteria for fibromyalgia (31/69 v 44/67, P=0.01). People in the exercise group also had greater reductions in tender point counts (4.2 v 2.0, P=0.02) and in scores on the fibromyalgia impact questionnaire (4.0 v 0.6, P=0.07). Prescribed graded aerobic exercise is a simple, cheap, effective, and potentially widely available treatment for fibromyalgia.
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To follow patients with fibromyalgia six and 24 months after they finished a six-month treatment programme. The programme comprised pool exercise therapy, adjusted to the patients' limitations, and education based on their health problems. Twenty-six patients were examined six and 24 months after the completion of the treatment programme with the Fibromyalgia Impact Questionnaire (FIQ), SF-36, the 6-minute walk test, and the Grippit measure. The values obtained at the follow-up examinations were compared with the baseline and post-treatment values. As compared with baseline, symptom severity (FIQ, SF-36), physical function (FIQ, SF-36, 6-minute walk test) and quality of life (SF-36) still showed improvements six months after the completion of treatment (p <0.05). Pain (FIQ, SF-36), fatigue (FIQ, SF-36), walking ability, and social function (SF-36) still showed improvements 2 years after the completion of the programme as compared with the baseline values (p < 0.05). No significant changes were found for these variables, when the values obtained at the two follow-up examinations were compared with those of the post-treatment examination. Improvements in symptom severity, physical function and social function were still found six and 24 months after the completed treatment programme.
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SVEDENHAG, J. and J. SEGER. Running on land and in water: comparative exercise physiology. Med. Sci. Sports Exerc., Vol. 24, No. 10, pp. 1155-1160, 1992. The effect of water immersion on cardiorespiratory and blood lactate responses during running was investigated. Wearing a buoyant vest, 10 trained runners (mean age 26 yr) ran in water at four different and specified submaximal loads (target heart rates 115, 130, 145, and 155-160 beats[middle dot]min-1) and at maximal exercise intensity. Oxygen uptakes ([latin capital V with dot above]O2), heart rates, perceived exertion, and blood lactate concentrations were measured. Values were compared with levels obtained during treadmill running. For a given [latin capital V with dot above]O2, heart rate was 8-11 beats[middle dot]min-1 lower during water running than during treadmill running, irrespective of exercise intensity. Both the maximal oxygen uptake (4.03 vs 4.60 1[middle dot]min-1) and heart rate (172 vs 188 beats[middle dot]min-1) were lower during water running. Perceived exertion (legs and breathing) and the respiratory exchange ratio (RER) were higher during submaximal water running than during treadmill running, while ventilation (1-min-1) was similar. The blood lactate concentrations were consistently higher in water than on the treadmill, both when related to [latin capital V with dot above]O2 and to %[latin capital V with dot above]O2max. Partly in conformity with earlier cycle ergometer studies, these data suggest that immersion induces acute cardiac adjustments that extend up to the maximal exercise level. Furthermore, both the external hydrostatic load and an altered running technique may add to an increased anaerobic metabolism during supported water running. (C)1992The American College of Sports Medicine
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The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
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Objectives: The goals of this study were to determine the effects of an exercise program on physical fitness and perceived benefits among fibromyalgia syndrome [FMS] patients. Methods: Patients were randomly assigned [ratio 2:1, anticipating dropout] to a fitness intervention [FI, N = 58] group or a nonintervention [NI, N = 27] group. In both groups, physical fitness [maximal power output, muscular strength/endurance, flexibility, coordination] and body composition were measured before and after the six-month observation period. The Fl-group underwent a fitness program two times per week for six months while the NI-group continued their usual activity undirected. Benefits perceived by the Fl-group were assessed six months after finishing the study. Results: The dropout rate among the FI group was lower than expected [45 of 58 completed], while 27 of 29 in the NI-group completed. Despite randomization, completing Fl-group subjects were older than the NI-group [mean ages 47 ± 8 versus 42 ± 8 years]. The NI-group exhibited a decrease in peak power output and peak heart rate during the study period. Surprisingly, the same was true for the Fl-group where the mean peak power output declined from 233 ± 28 Watts to 112 ± 23 Watts and the mean peak heart rate declined from 153 ± 20 to 145 ± 17. Most of the FI-group subjects [83%] perceived benefits [physical, social] from the exercise program and continued it at their own expense. Conclusions: The fitness program failed to improve the apparent physical fitness in the FMS patient participants but the majority believed they had benefited and elected to continue it.
Article
Objectives: Previous studies have shown some efficacy of physical fitness training in patients with fibromyalgia [FMS]. The purpose of this study was to evaluate a steady exercise program and an aerobic dance program in treatment of FMS. Methods: Of 176 patients invited to participate only 38 [22%] volunteered. Fifteen were randomized to a slowly increasing dance program three times a week, 15 to a steady exercise program twice a week and eight received hot packs twice a week as a control intervention. All treatments continued for 12 weeks. Results: Only five in the aerobic group, eleven in the steady exercise group and seven of those receiving hot packs completed the trial. After 12 weeks there was no improvement in pain, fatigue, general condition, sleep, Beck's depression score, functional status, muscle strength or aerobic capacity in any of the groups. Conclusion: The very low percentage of volunteers, the high percentage of withdrawals, and the absence of improvement in aerobic capacity illustrate the difficulty in treating FMS with physical modalities.
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Purpose. The purpose of this study was to examine the effects of self-efficacy on self-report pain and physical activities among subjects with fibromyalgia (FM). In addition, descriptive statistics of the Arthritis Impact Measurement Scale (AIMS), a measure developed for use with arthritis patients, were reported.Methods. Seventy-nine subjects with FM, as classified by the American College of Rheumatology (ACR) criteria, completed the Visual Analogue Scale for Pain, the AIMS, and the Arthritis Self-Efficacy Scale. A myalgic score was obtained during a tender point evaluation. Hierarchical multiple regression analyses were used to assess the effect of self-efficacy on self-report pain and physical activities measures after controlling for demographic variables (age, education, and symptom duration), disease severity (myalgic scores), and psychological distress (negative affect from the AIMS).Results. Higher self-efficacy was associated with less pain and less impairment on the physical activities measure after controlling for demographic and disease severity measures.Conclusions. This study underscores the unique importance of self-efficacy in understanding pain and physical activities impairment.
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Aerobic fitness was evaluated in 25 women with fibrositis, by having them exercise to volitional exhaustion on an electronically braked cycle ergometer. Compared with published standards, >80% of the fibrositis patients were not physically fit, as assessed by maximal oxygen uptake. Compared with matched sedentary controls, fibrositis patients accurately perceived their level of exertion in relation to oxygen consumption and attained a similar level of lactic acidosis, as assessed by their respiratory quotient and ventilatory threshold. Exercising muscle blood flow was estimated by 133xenon clearance in a subgroup of 16 fibrositis patients and compared with that in 16 matched sedentary controls; the fibrositis patients exhibited reduced 133xenon clearance. These results indicate a need to include aerobic fitness as a matched variable in future controlled studies of fibrositis and suggest that the “detraining phenomenon” may be of relevance to the etiopathogenesis of the disease.
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To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
Article
Forty-two patients with primary fibromyalgia were randomized into a 20-week program consisting of either cardiovascular fitness (CVR) training or simple flexibility exercises (FLEX) that did not lead to enhanced cardiovascular fitness. Patients were supervised by the same medical fitness instructors. Patients in neither group had contact with members of the other group, and were blinded as to the exercise taught to the alternative group. Groups met for 60 minutes 3 times each week. The compliance rate was 90%. Thirty-eight patients completed the study (18 with CVR training and 20 with FLEX). Blind assessments (standardized in preliminary trials to achieve acceptable inter-rater agreement) were performed by the same 2 examiners. After 20 weeks, patients receiving CVR training showed significantly improved cardiovascular fitness scores compared with those receiving FLEX training (t[35] = -4.22, P less than 0.003). Logistic regression analysis showed clinically and statistically significant improvements in pain threshold scores, which were measured directly over fibrositic tender points, in patients undergoing CVR (t[35] = 2.21, P less than 0.04). There was also a trend toward improvement in pain scores (visual analog scale) in the CVR group, but this did not reach statistical significance. There was no improvement in the percentage of body area affected by fibrositic symptoms or the number of nights per week or hours per night of disturbed sleep (self-report inventories). However, compared with the FLEX group, the CVR-trained patients improved significantly in both patient and physician global assessment scores.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Two groups of young, healthy, nonathletic volunteers were subjected to selective sleep stage deprivation. Six subjects were deprived of stage 4 sleep and seven subjects of REM sleep. The stage 4 deprived group reported more musculoskeletal symptoms during the deprivation condition than did the REM deprived group. The stage 4 deprived group also showed a significant increase in muscle tenderness between the baseline and deprivation conditions and an altered pattern of overnight change in muscle tenderness in response to deprivation. The REM deprived group did not show either of these changes. These results are discussed in the light of the previously postulated relationship between NREM sleep disturbance and muscoloskeletal pain in patients with so-called "Fibrositis syndrome."