Analysis of the performance of women with fibromyalgia in the six-minute walk test and its relation with health and quality of life.
Pedro Ángel Latorre RománMaria Santos-CamposJosé María Heredia JiménezManuel Delgado‐FernándezVíctor M. Soto-Hermoso
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Abstract:
Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain that causes a significant reduction in functional capacity, affecting thus health and quality of life (QOL).The aim of the present study was to evaluate the performance of FM patients in the 6-Minute Walk Test (6MWT) and its relation with health and QOL.Thirty-six FM patients (all women), differentiated by degree of severity of disease, and 14 healthy women were evaluated. Distance walked in the 6MWT, cardiorespiratory responses, heart rate responses, kinematic parameters of gait, the results of the Fibromyalgia Impact Questionnaire (FIQ), and the results of the Short-Form Healthy Survey (SF-36) were analyzed.Women with FM covered a shorter distance in the 6MWT, had a lower cardiorespiratory response, and had lower spatio-temporal parameters of gait than healthy women. No correlation was found in FM patients between the total FIQ score and the distance walked in the 6MWT.The analysis of performance parameters in the 6MWT may be an element of clinical relevance in FM patients.Cite
Background
Kinesiophobia play an important role in the development of chronic pain in Fibromyalgia (FM) patients. This condition lead to increase clinical symptoms and reduce quality of life.Objectives
The aim of the study is to examine the effects of kinesiophobia on pain, fatigue, functional exercise capacity,functional status and quality of life in FM patients.Methods
Twenty-one FM patients were evaluated. We used Tampa Scale of Kinesiophobia (TSK) for perception kinesiophobia, Visual Analogue Scale (VAS) for pain intensity, Fatigue Severity Scale (FSS) for fatigue, six-minute walk test (6MWT) for functional capacity, Fibromyalgia Impact Questionnaire (FIQ) for the functional status, and Short-Form Health Survey (SF-36) for quality of life.Results
The results of this study, there was a strong correlation between TSK and VAS, FSS, physical and mental components of SF-36 (r=0.754, r=0.762, r=0.780, and r=0.843, respectively; p<0.05). There was a moderate correlation between TSK and FIQ and 6MWT (r=0.695, r=0.510, respectively; p<0.05).Conclusions
The results of the present study indicate that kinesiphobia can adversely affect pain, fatigue, functional status and functional exercise capacity, which is result in impaired quality of life in FM. Further, it demonstrates kinesiophobia can be a clinically appropriate assessment to evaluate patients and to determine the effectiveness of treatments in FM.Disclosure of Interest
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It is accepted that the optimal management of patients with fibromyalgia (FM) requires a combination of non-pharmacological and pharmacological interventions. Our study aimed to analyse the effects of a supplemented physical programme on the quality of life of FM patients.We enrolled 60 patients, all female (mean age 49±5.7 years), with primary FM (mean years of disease 33±12 months). Patients who agreed to participate in this study met the proposed 1990 American College of Rheumatology classification criteria and the 2010 American College of Rheumatology preliminary diagnostic criteria and were recruited at Policlinico P. Giaccone, University Hospital of Palermo, Italy. Thirty patients undertook a physical programme consisting of group exercises, laser and TENS treatment (Combi-group). The remaining 30 FM patients (Exonly-group) practiced only group exercise (Control group). Ten patients with mechanical pain were considered as unrelated control group disease. Fatigue, sleep dysfunction and pain were reported and evaluated before and after the treatment for each patient. Particularly, the Fibromyalgia Impact Questionnaire (FIQ), SF36 Questionnaire (SF36) and Visual analogue scale for pain and fatigue (VAS pain and fatigue) were administered at baseline (T0) and at the end of the treatment (T1) (after 40 rehabilitation sessions over 20-week).The combined treatment significantly improved the perception of pain and fatigue and the overall quality of life. In detail, the Combi-group experienced a statistically significant improvement in FIQ but not in the SF36 after the treatment.According to our results, an intense physical rehabilitation programme could be considered a promising essential step in the management of FM patients.
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Fibromyalgia is a chronic widespread unexplained musculoskeletal pain syndrome with decreased pain threshold. Because the etiology of fibromyalgia is unknown and the pathogenesis is unidentified, treatment is largely symptomatic and not standardised. The pain and fatigue reported by individuals with fibromyalgia results in a relative sedentary lifestyle, hence also a decrease in the fitness level of skeletal muscles.In order to assess the effect of exercise in fibromyalgia, the Cochrane Controlled Trials Register was reviewed; 17 studies of exercise interventions on cardiorespiratory endurance, muscle strength and/or flexibility were selected.The results from the studies are inconsistent but low-intensity aerobic exercise regimens were found to be one of the few effective treatments. In these studies, however, subjective pain levels fail to show significant improvement, although improvements are seen on other parameters such as improvement in the number of tender points, in total myalgic scores and reduced tender point tenderness, improved aerobic capacity, physical function, subjective well-being and self-efficacy.The group exercises varied from 1-3 times per week, sessions from 25 minutes to 90 minutes; the duration of the programmes from 6 weeks to 6 month. Most of the programmes were low-intensity dynamic endurance training with a working rate at 50-70 % of maximal heart rate in relation to age.
Aerobic Exercise
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To determine the concurrent validity and responsiveness of the 6 minute walk test (6-MWT) as a measure of cardiorespiratory fitness in people with fibromyalgia.Subjects completed the 6-MWT, a Fibromyalgia Impact Questionnaire (FIQ), and a peak oxygen consumption (pVO2) exercise test before (n = 28) and after (n = 20) a 12 week exercise program.The correlations between 6-MWT distance and pVO2 before (r = 0.328) and after (r = 0.420) the exercise program were not significant. Significant correlations were obtained between 6-MWT distance and FIQ total (r = -0.494, p < 0.01) and physical impairment (r = -0.403, p < 0.05) scores. Fifteen of 28 subjects completed the exercise program, with significant (p < 0.05) changes in 6-MWT distance (+78 m), pVO2 (+1.8 ml/kg/min), and FIQ total score (-9.9). The change in 6-MWT distance was correlated significantly (p < 0.05) with change in FIQ total score but no change in pVO2.The 6-MWT was not a valid predictor of cardiorespiratory fitness. However, it was sensitive to change and was also significantly related to FIQ total score.
Fibromyalgia syndrome
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This review presents and addresses the conflicting results on cardiorespiratory fitness among adults with fibromyalgia. The heterogeneity in study designs, symptom severity and the assessment protocols might partly explain these conflicting results. It also presents the possible relationship between cardiorespiratory fitness and exercise prescription, attrition from exercise/rehabilitation programmes and independence with activities of daily living. Cardiorespiratory fitness might impact aerobic exercise and independence in daily activities of patients with fibromyalgia, which is often concomitantly diagnosed in patients with sleep disordered breathing, including patients with obstructive sleep apnoea. Therefore, cardiorespiratory fitness evaluation should be considered by general and respiratory physicians as well as physiotherapists who treat patients diagnosed with fibromyalgia for more accurate diagnosis, exercise prescription and monitoring of patients’ status. Key points Adults with fibromyalgia often present with reduced cardiorespiratory fitness. Reduced cardiorespiratory fitness might have an important impact on functional capacity and quality of life. Adults with fibromyalgia who have a secondary condition affecting their ventilatory anaerobic threshold and/or V ′ O 2 peak , for example chronic obstructive pulmonary disease, might present with a greater reduction of their cardiorespiratory fitness which may not be entirely related to their lung disease. Educational aims To better understand the cardiorespiratory fitness results among adults with fibromyalgia in general, and when taking into account differences in assessment protocol (maximal versus submaximal testing protocol; cycle ergometer versus treadmill testing protocol) and symptom severity (fibromyalgia severity level). To better understand how cardiorespiratory fitness among adults with fibromyalgia could: 1) assist in exercise prescription; 2) minimise dropout rates from exercise/rehabilitation programmes; and 3) promote independence with activities of daily living. To learn why fibromyalgia might be important to consider in adults who have concurrent fibromyalgia and lung disease.
Exercise prescription
Aerobic Exercise
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There are evidences that physical exercise is an effective instrument for improving physical fitness, health, and quality of life and causes beneficial effects on the symptoms of patients with fibromyalgia. The purpose of this study was to analyze effects of a functional training program on pain, fitness, and quality of life in patients with fibromyalgia in a 9-year prospective longitudinal cohort study. Forty women with fibromyalgia participated in this study; 24 received an exercise program and were called the active group; and 16 were the control group. Tender points, visual analogical scale (VAS) of pain, physical fitness, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form Health Survey 36 (SF-36) were analyzed. The active group experienced significant improvements in FIQ, TP, and VAS (P < .001), whereas the control group showed significant worsening in the FIQ scale (P = .004). Moreover, the active group experienced significant improvements in leg strength (P < .001), balance (P = .033), cardiorespiratory fitness (P < .001), emotional role (P = .024), and mental health (P = .025); whereas the control group significantly worsened on handgrip strength (P = .017), balance (P = .043), cardiorespiratory fitness (P = .020), and in general health (P < .001). A Pearson correlation analysis revealed a significant relationship between the improvement in physical fitness variables and the improvements in FIQ, TP, and VAS. In conclusion, a regular practice of moderate-intensity physical activity shows a positive effect long-term on fitness, pain, the impact of the disease, and the quality of life in women with fibromyalgia.
Longitudinal Study
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Objectives. To study the effect of a combination of thalassotherapy, exercise and patient education in people with fibromyalgia.
Depression
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BACKGROUND AND OBJECTIVES: Fibromyalgia syndrome is characterized by diffuse and chronic musculoskeletal pain, which is difficult to handle and negatively affects patients' quality of life. This study aimed at measuring fear of movement, adherence to treatment and at evaluating health-related quality of life of fibromyalgia syndrome patients. METHODS: This is a prospective study in convenience sample made up of individuals with fibromyalgia syndrome and treated in a Pain Outpatient Clinic. Tools used were: identification protocol, Fibromyalgia Impact Questionnaire, generic quality of life questionnaire World Health Organization's Quality of Life Instrument, visual analog scale, Tampa Scale for Kinesiophobia and treatment adherence measurement. Participated in the study 65 individuals being 35 with fibromyalgia syndrome called test group and 30 without diagnostic of musculoskeletal and neurological systems diseases called control group. RESULTS: The test group had predominance of females, mean age of 42.5±4.3 years, 53% were married and mean education was 9±2.5 years. Mean pain duration was 3.5±1.2 years and mean of two years for fibromyalgia syndrome diagnostic. There has been poorer quality of life, more severe pain and acknowledgment of the importance of physical activities, in spite of referring fear. In addition, adherence to pharmacological treatment was lower than that observed in the control group. CONCLUSION: Fibromyalgia patients had more severe pain, more fear of movement and poorer quality of life in physical an social domains. Adherence to treatment level was medium and there has been decreased functional capacity.
Fibromyalgia syndrome
Outpatient clinic
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Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain that causes a significant reduction in functional capacity, affecting thus health and quality of life (QOL).The aim of the present study was to evaluate the performance of FM patients in the 6-Minute Walk Test (6MWT) and its relation with health and QOL.Thirty-six FM patients (all women), differentiated by degree of severity of disease, and 14 healthy women were evaluated. Distance walked in the 6MWT, cardiorespiratory responses, heart rate responses, kinematic parameters of gait, the results of the Fibromyalgia Impact Questionnaire (FIQ), and the results of the Short-Form Healthy Survey (SF-36) were analyzed.Women with FM covered a shorter distance in the 6MWT, had a lower cardiorespiratory response, and had lower spatio-temporal parameters of gait than healthy women. No correlation was found in FM patients between the total FIQ score and the distance walked in the 6MWT.The analysis of performance parameters in the 6MWT may be an element of clinical relevance in FM patients.
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