Food consumption, physical activity and aerobic capacity in systemic lupus erythematosus patients with high cardiovascular risk.

Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune and multisystemic rheumatic disease. Patients with SLE have decreased functional and aerobic capacity, as well as increased prevalence of Cardiovascular Diseases (CVD), which are the primary causes of morbimortality in this condition. Dietary intake and physical activity are well-known modifiable cardiovascular risk factors. The aim of this study is to describe food consumption, sedentary behavior, physical activity level, and functional and aerobic capacity in a sample of SLE patients with high cardiovascular risk. This was a cross-sectional study in which patients were assessed for (i) Demographic, anthropometric, and disease-related parameters; (ii) Food consumption; (iii) Physical activity level and sedentary behavior; (iv) Functional and aerobic capacity. Patients averaged 41.7 ± 9 years, and most were classified as overweight/obese (87%). Average macronutrient intake was within recommendations; however, fiber (16 ± 9g) and calcium (391 ± 217 mg) intakes were below, and sodium intake (2.9 ± 1.3 mg) was above recommendations. Besides, food consumption assessed by the Nova system showed a predominance of unprocessed foods (43.8 ± 14.0%TEI), although ultraprocessed food intake (20.0 ± 13.9%TEI) was slightly higher than that seen in the Brazilian population. Patients also exhibited high sedentary behavior (8.2 ± 2.2h) and only eighteen participants reached the minimum recommended amount of moderate-to-vigorous physical activity. Overall, patients had a low functional and aerobic capacity compared to the general population. Data from this study may help design dedicated clinical trials aiming to investigate the effects of lifestyle intervention to mitigate CVD in SLE.

Food consumption, physical activity and aerobic capacity in systemic lupus erythematosus patients with high cardiovascular risk

Abstract Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune and multisystemic rheumatic disease. Patients with SLE have decreased functional and aerobic capacity, as well as increased prevalence of Cardiovascular Diseases (CVD), which are the primary causes of morbimortality in this condition. Dietary intake and physical activity are well-known modifiable cardiovascular risk factors. The aim of this study is to describe food consumption, sedentary behavior, physical activity level, and functional and aerobic capacity in a sample of SLE patients with high cardiovascular risk. This was a cross-sectional study in which patients were assessed for (i) Demographic, anthropometric, and disease-related parameters; (ii) Food consumption; (iii) Physical activity level and sedentary behavior; (iv) Functional and aerobic capacity. Patients averaged 41.7 ± 9 years, and most were classified as overweight/obese (87%). Average macronutrient intake was within recommendations; however, fiber (16 ± 9g) and calcium (391 ± 217 mg) intakes were below, and sodium intake (2.9 ± 1.3 mg) was above recommendations. Besides, food consumption assessed by the Nova system showed a predominance of unprocessed foods (43.8 ± 14.0%TEI), although ultraprocessed food intake (20.0 ± 13.9%TEI) was slightly higher than that seen in the Brazilian population. Patients also exhibited high sedentary behavior (8.2 ± 2.2h) and only eighteen participants reached the minimum recommended amount of moderate-to-vigorous physical activity. Overall, patients had a low functional and aerobic capacity compared to the general population. Data from this study may help design dedicated clinical trials aiming to investigate the effects of lifestyle intervention to mitigate CVD in SLE.

A randomized controlled trial of an intervention promoting physical activity and healthy eating recommendations in systemic lupus erythematosus: the protocol study "Living Well with Lupus".

There is a paucity of studies assessing multidisciplinary interventions focused on tackling physical inactivity/sedentary behavior and poor dietary habits in SLE. The Living well with Lupus (LWWL) is a randomized controlled trial to investigate whether a six-month lifestyle change intervention will improve cardiometabolic risk factors (primary outcome) among systemic lupus erythematosus (SLE) patients with low disease activity (SLEDAI score ≤ 4) and with high cardiovascular risk. As secondary goals, we will evaluate: (1) the intervention's safety, efficacy, and feasibility in promoting lifestyle changes, and (2) the effects of the intervention on secondary outcomes (i.e., clinical parameters, functional capacity, fatigue, psychological aspects, sleep quality and health-related quality of life). Patients will be randomly allocated to either a control (i.e., standard care) or a lifestyle intervention group using a simple randomization (1:1 ratio, blocks of 20). Mixed Model analyses will be conducted for comparing groups following an intention-to-treat approach. A per protocol analysis will also be conducted. This study has the potential to generate new, clinically relevant data able to refine the multidisciplinary management of SLE patients. Protocol version number: NCT04431167 (first version).

In-depth cardiovascular and pulmonary assessments in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: A case series study.

We assessed PET-CT myocardial blood flow (MBF) using N-13 ammonia, brachial flow-mediated dilation, and cardiopulmonary exercise test in five post-discarged MIS-C survivors. None of the patients (median age: 9, range: 7-18 years; 3 females; 2 males) had preexisting pediatric chronic conditions. At the follow-up visit, two patients exhibited severe perfusion defect developed in the left ventricular cavity, suggesting extensive myocardial ischemia (MBF <2.0) and one patient showed persistent mild pericardial effusion. Others two patients demonstrated endothelial dysfunction. Nevertheless, all patients had lower predicted values in the VO2peak , VO2VAT , OUES, and O2 Pulse (range: 35.2%-64.5%; 15.6%-38.2%; 1.0-1.3 L/min; 4-7 ml/beat), respectively. Our d suggested that previously health MIS-C patients had impaired MBF, endothelial dysfunction and lower cardiopulmonary capacity at follow-up analysis. Multidisciplinary further investigations should be conducted to reinforce these findings.

Resistance training reduces pain in women with fibromyalgia / O treinamento resistido reduz a dor em mulheres com fibromialgia

Resistance training (RT) is an intervention strategy for the treatment of fibromyalgia (FM) that has low cost, easy access, easy application and a positive effect on general health maintenance. Objective:To investigate the effect of four weeks of RT on pain in patients with FM. Method:This is a non-randomized controlled clinical trial with fifty-four women with FM (age: 53.74 ± 8.54 years). Patients were allocated to the intervention group (n= 33) and the control group (n= 21). The intervention consisted of a four-week supervised RT program. For pain assessment, an algometer and a visual analogue scale were used. To assess differences after the intervention, ANOVA two-way was used. Results:Patients in the intervention group had a significant reduction in pain perception and increased pain threshold, but there was no difference when compared to the control group. Conclusions:The practice of RT for four weeks reduces the pain of patients with FM; however, no significant differences were found with the control group. For this reason, the significant results of this study should be considered with caution, reinforcing the need for further studies.

O treinamento resistido (TR) é uma estratégia de intervenção para o tratamento da fibromialgia (FM) que possui baixo custo, fácil acesso, fácil aplicação e efeito positivo na manutenção geral da saúde. Objetivo: Investigar o efeito de quatro semanas de TR na dor de pacientes com FM. Método: Trata-se de um ensaio clínico controlado não randomizado com cinquenta e quatro mulheres com FM (idade: 53,74 ± 8,54 anos). As pacientes foram alocadas no grupo intervenção (n= 33) e no grupo controle (n= 21). A intervenção consistiu em quatro semanas de um programa de TR supervisionado. Para a avaliação da dor foi utilizado um algômetro e a escala visual analógica. Para avaliar as diferenças após a intervenção, foi utilizada a ANOVA de dois fatores. Resultados: Os pacientes do grupo intervenção tiveram redução significativa da percepção da dor e aumento do limiar de dor, mas não houve diferença quando comparados ao grupo controle. Conclusão: A prática do TR por quatro semanas reduz a dor de pacientes com FM, entretanto, não foram encontradas diferenças significativas com o grupo controle. Por esse motivo, os resultados significativos deste estudo devem ser considerados com cautela, reforçando a necessidade de novos estudos.

Acute effect of strength training on pain in women with fibromyalgia: A brief report.

OBJECTIVE: The aim was to analyze the effect of one session and three sessions of strength training (ST) on pain in women with fibromyalgia (FM). METHOD: Twenty-three women with FM performed three sessions of ST for a week. Each training session worked the main muscle groups and lasted 60 min. Three sets of 12 repetitions were performed with 1 min intervals in between. The load was increased based on the perception of subjective effort of each patient. Pain intensity was evaluated immediately after the first and third sessions using a Fischer digital algometer. RESULTS: After the first ST session, pain reduction was observed. No significant differences were found in pain thresholds on the baseline versus the third session. The analysis of MBI demonstrated that the ST does not worsen patients' pain, indicating a 52.2% trivial effect and a 39.1% beneficial effect. CONCLUSION: Our results suggest that there is no harmful effect on the pain of women with FM after an acute session of ST. We emphasize that despite the promising results, more studies on the subject are needed to help understand pain in patients with FM.

What we already know about the effects of exercise in patients with fibromyalgia: An umbrella review.

We aimed to analyze the evidence on the effects of physical exercise in patients with fibromyalgia (FM) and to assess the characteristics of published studies, especially the quality of the evidence, through an umbrella review. This umbrella review followed the PRISMA guidelines and was documented in the PROSPERO registry (CRD42017075687). We searched the PubMed, Web of Science, SportDiscus, Scopus, Cinahl, and Cochrane Library databases. The methodological quality of systematic reviews was assessed using AMSTAR 2. We only selected systematic reviews (with or without meta-analyses) investigating the effects of any type of physical exercise in patients with FM syndrome. Thirty-seven systematic reviews (total = 477) fulfilled the criteria. Most studies were rated as being of low or moderate quality. A variety of exercises were used as treatment for FM symptoms, with positive results. Most of the reviews investigated the effects of aerobic exercise and strength training. No serious adverse events were reported. The largest effects of exercise were seen in terms of improved pain intensity and quality of life. Altogether, exercise may be an effective treatment for FM symptoms. Thus, aerobic exercise and strength training are effective programs for the treatment of FM. By summarizing the findings and effect sizes of the reviewed studies, we observed that the evidence for improvement of pain level and quality of life was the strongest. The results have potential to influence evidence-based practice. Future studies should analyze the long-term effects of exercise.

The relationship between sleep quality and fibromyalgia symptoms.

This study investigated the relationship between sleep quality and fibromyalgia symptoms in 326 patients. The Pittsburgh Sleep Quality Index was used to assess the presence of sleep disorders. Multivariate analysis of variance was performed to determine the influence of fibromyalgia symptoms on sleep quality. The prevalence of sleep disorders was 92.9 percent. Patients reported generalized pain (88.3%), memory failure (78.5%), moodiness (59%), excessive anxiety (77.5%), and concentration difficulties (69.1%). Patients with more symptoms reported poor sleep quality (p < .05; d = .74), and the total Pittsburgh Sleep Quality Index score correlated with the number of symptoms (p < .01). Sleep quality has an important association with fibromyalgia symptoms.

Does physical exercise improve quality of life in patients with fibromyalgia?

BACKGROUND: To compare patients with active and inactive fibromyalgia to better understand the impact of physical inactivity on quality of life and symptoms in these patients. METHODS: A total of 304 patients were eligible for the study, 20 were excluded for reasons of health, work, or unavailability to perform the collection. Data were collected to assess sociodemographic and clinical characteristics, physical exercise, sleep, and quality of life. Patients were classified as active (performed physical exercise) or inactive (did not perform physical exercise). Sleep was assessed using the Pittsburgh Sleep Quality Index and quality of life was assessed using the Fibromyalgia Impact Questionnaire. RESULTS: Of the 284 final participants, 97.9% were women, with a mean age of 50.39 ± 10.31 years. Most did not exercise regularly and did not work, and most used antidepressant drugs and muscle relaxants. Patients who exercised regularly had a better overall quality of life than those who did not; moreover, inactive patients had a 1.77-fold likelihood of a greater impact on quality of life, and those with poor sleep quality had a 10.79-fold likelihood. CONCLUSIONS: Our results reinforce the understanding that exercise can reduce symptoms of fibromyalgia and suggests that patients who practice physical exercise have a better quality of life, with fewer depressive symptoms and absences from work, and better sense of well-being.

Modulation of Autonomic Function by Physical Exercise in Patients with Fibromyalgia Syndrome: A Systematic Review.

OBJECTIVE: To evaluate the effects of physical exercise on autonomic dysfunction in patients with fibromyalgia syndrome (FM). LITERATURE SURVEY AND METHODOLOGY: A systematic review of experimental studies published until December 2017 that analyzed the effect of physical exercise on autonomic dysfunction in patients with FM was performed using the PubMed, Pedro, Scopus, ScienceDirect, and Web of Science databases. SYNTHESIS: A total of 1105 articles were identified, 12 of which were included in the final analysis. The most analyzed exercise modalities were aerobic and resistance exercises. Overall, the studies demonstrated that aerobic exercise performed twice a week with moderate to high intensity was effective in reducing autonomic dysfunction by increasing heart rate variability. Resistance training was associated with reduced symptoms of anxiety and depression as well as increased muscle strength; however, it did not reduce autonomic dysfunction in these patients in the short or long term. CONCLUSIONS: Preliminary evidence suggests that aerobic exercise reduces autonomic dysfunction in patients with FM, whereas resistance training reduces psychological symptoms such as anxiety and depression. LEVEL OF EVIDENCE: I.

Acute effects of physical exercises on the inflammatory markers of patients with fibromyalgia syndrome: A systematic review.

OBJECTIVE: In patients with fibromyalgia (FM), exercise is indicated for symptomatic treatment. However, little is known about the inflammatory response to acute exercise in these patients. This study examines the acute effects of exercise on the inflammatory response in patients with FM. METHODS: A systematic review was conducted using PubMed, PsycINFO, Web of Science, SportDiscus, Scopus, Virtual Health Library (VHL), and Cochrane Library databases. RESULTS: Six studies that met the inclusion criteria were included in the analysis; three of them evaluated the effects of resistive exercise, while three evaluated the effects of aerobic exercise. Several studies evaluated pro-inflammatory (interleukin [IL]-6, IL-8, IL-1ß, IL-18, tumor necrosis factor-α) and anti-inflammatory cytokine levels (IL-10) and stress (Hsp72) protein levels before and after the intervention with exercise. Studies found a low-grade baseline chronic inflammatory state in patients with FM, demonstrated by the alteration of one or more of the studied markers. CONCLUSIONS: We suggest that patients with FM probably have low-grade chronic inflammation, because studies found higher concentrations of IL-8 and TNF-α and high expression of IL-10 in these patients; however, the effects of exercise on the inflammatory markers in these patients are unclear. Although more research is needed on the effect of exercise on inflammation, none of the studies reported worsening of symptoms with exercise recommended as treatment.

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

BACKGROUND: Fibromyalgia (FM) is characterized by chronic and generalized musculoskeletal pain. There is currently no cure for FM, but palliative treatments are available. One type of treatment is strength training (ST). However, there is a need for more information on optimal training protocols, intensity, and volume needed to improve symptoms. The aim of this study was to analyze the effects of ST in the treatment of FM through a systematic review of experimental research. METHODS: Medical Subject Headings search terms and electronic databases including Scientific Electronic Library Online, PubMed, Science Direct, Web of Science, and Physiotherapy Evidence Database were used to identify studies. RESULTS: The inclusion criteria were met by 22 eligible studies. Most of the studies were conducted in the United States (36%), Finland (23%), Brazil (18%), and Sweden (18%). The studies showed that ST reduces the number of tender points, fatigue, depression, and anxiety, and improves sleep quality and quality of life in patients with FM. The intervention period ranged from 3 to 21 weeks, with sessions performed 2 times a week in 81.81% of the studies, at initial intensities of 40% of 1-repetition maximum. The repetitions ranged from 4 to 20, with no specific protocol defined for ST in FM. CONCLUSION: The main results included reduction in pain, fatigue, number of tender points, depression, and anxiety, with increased functional capacity and quality of life. Current evidence demonstrates that ST is beneficial and can be used to treat FM. TRIAL REGISTRATION: CRD42016048480.

Does volume of physical exercise have an effect on depression in patients with fibromyalgia?

BACKGROUND: Fibromyalgia Syndrome (FMS) is a musculoskeletal disorder frequently associated with depression. We aimed to investigate the association between physical exercise (PE) and depression in patients with FMS, and to evaluate the effect of the weekly volume of PE on depression. METHODS: A total of 215 FMS patients with depression were evaluated with the Beck Depression Inventory, and were also classified as inactive, insufficiently active, or active. We performed binary logistic regression, with PE as the dependent variable and the level of depression as an independent variable. We also used the Mann-Whitney U test. An alpha value of 0.05 was determined to have significance (p<0.05). RESULTS: Inactive patients with FMS have a higher rate of moderate to severe depression (29.1%) and major depression (25%) when compared with active patients. In comparing the depression index between inactive, insufficiently active, and active FMS patients according to the reported weekly volume of PE, we observed differences between inactive and active patients (p=0.035). The level of depression was positively associated with physical inactivity in FMS, and FMS patients with severe depression had 3.45 1.23-9.64) times the likelihood of being inactive than patients without depression or with minimal depression. LIMITATIONS: The classification of PE does not distinguish between types of PE, or whether differences in activity can have different results in depression. CONCLUSION: There was an association between PE and lower values of depression in patients with FMS, and the level of depression was positively and significantly associated with physical inactivity.