Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial.

BACKGROUND: Aquatic physical training (APT) promotes improvement of clinical symptoms and aerobic functional capacity in women with fibromyalgia syndrome (FMS). However, there are controversial studies that refer to the maintenance of adaptations obtained from APT after a detraining period. AIM: To evaluate variables oxygen uptake (VO2) relative to lean body mass (LBM) and clinical symptomatology in women with FMS submitted to APT and after 16 weeks of detraining period, and to evaluate the association between the magnitude of VO2 improvement relative to LBM and clinical symptomatology. DESIGN: Blind randomized controlled trial. SETTING: Department of Physical Therapy of the Federal University of São Carlos. POPULATION: Fifty-four women with FMS were randomly assigned into trained group (27) and control group (27). METHODS: All women underwent cardiopulmonary exercise test (CPET) and body composition assessment to estimate VO2 and LBM respectively, and clinical symptoms were assessed before and after 16 weeks of training and detraining. trained group was submitted to APT program, performed twice a week for 16 weeks. RESULTS: After APT, trained group presented an increase in VO2 relative to LBM (P=0.01), in addition to an increase in pressure pain threshold (PPT) (P=0.02) and Visual Analogue Scale (VAS) pain (P=0.01), VAS well-being (P<0.01) well-being and lower Fibromyalgia Impact Questionnaire Score (FIQ) (P=0.04). However, these improvements were not maintained after the 16-week detraining period (P>0.05). In addition, no significant correlations were observed between improvement of clinical manifestations and increased VO2 relative to LBM after APT (P>0.05). CONCLUSIONS: APT contributed both to increase VO2 at VAT and peak CPET, and improved clinical symptoms, but no association was observed. However, after 16 weeks of detraining, these variables were reduced near baseline. CLINICAL REHABILITATION IMPACT: The results of the present study suggest that APT should be continuously performed in order to improve clinical symptomatology and increase the aerobic functional capacity in women with FMS.

The Borg CR-10 scale is suitable to quantify aerobic exercise intensity in women with fibromyalgia syndrome / A escala CR-10 de Borg é viável para quantificar a intensidade do exercício aeróbio em mulheres com síndrome fibromiálgica / La escala Borg CR-10 es adecuada para cuantificar la intensidad del ejercicio aeróbico en mujeres con síndrome de fibromialgia

ABSTRACT Patients with Fibromyalgia syndrome (FMS) report higher ratings of perceived exertion (RPE) compared to healthy individuals for the same exercise intensity; however, to our knowledge, no studies have evaluated RPE at the ventilatory anaerobic threshold (VAT) for this population. This study aimed to assess RPE using the Borg CR-10 scale during a cardiopulmonary exercise test (CPET) in women with FMS. Twenty-four women with FMS and twenty healthy control subjects (HC) voluntarily participated in this study. Near the end of every 1-minute period during CPET, subjects were asked to report their RPE for fatigue in the lower limbs (RPE-L) and dyspnea (RPE-D), respectively, according to the Borg CR-10 scale. FMS subjects showed higher RPE-L and RPE-D compared to HC subjects at free wheel and at the first load increment. However, no significant difference was observed between groups for power output. There was no significant difference between groups for RPE-L and RPE-D reported at VAT and peak CPET. However, FMS subjects showed lower power output compared to HC subjects. The present results showed that FMS subjects present higher RPE compared to HC subjects. However, RPE reported at VAT and at peak CPET was not different between groups. The Borg CR-10 scale scores obtained at VAT can be used as an additional parameter for prescribing exercise intensity in aerobic training protocols for women with FMS.

RESUMO Pacientes com síndrome fibromiálgica (SFM) relatam elevados níveis de percepção subjetiva de esforço (PSE) em comparação com indivíduos saudáveis para a mesma intensidade de exercício; no entanto, a nosso conhecimento, nenhum estudo avaliou a PSE no limiar de anaerobiose ventilatório (LAV) para essa população. Este estudo buscou avaliar PSE usando a escala CR-10 de Borg durante um teste de exercício cardiopulmonar (TECP) em mulheres com SFM. Vinte e quatro mulheres com SFM e vinte indivíduos saudáveis (GS) participaram deste estudo voluntariamente. Perto do final de cada período de 1 minuto durante CPET, os indivíduos foram convidados a relatar sua PSE para fadiga nos membros inferiores (PSE-MMII) e dispneia (PSE-D), respectivamente, de acordo com a escala CR-10 de Borg. Os indivíduos com SFM mostraram maior PSE-MMII e PSE-D, em comparação com indivíduos GS tanto na carga livre como no primeiro incremento de carga. No entanto, não houve diferença significativa entre os grupos para a potência e nem para PSE-MMII e PSE-D relatado no LAV e no pico TECP. No entanto, indivíduos com SFM mostraram baixa potência em comparação com indivíduos GS. Esses resultados mostraram que indivíduos com SFM apresentam a PSE mais elevada em comparação com indivíduos GS. No entanto, a PSE relatada no LAV e no pico TECP não foi diferente entre os grupos. As pontuações de escala CR-10 de Borg obtidas no LAV podem ser usadas como um parâmetro adicional para a prescrição da intensidade de exercício nos protocolos de treinamento aeróbio para mulheres com SFM.

RESUMEN Los pacientes con síndrome de fibromialgia (FMS) reportan índices más altos de esfuerzo percibido (RPE) en comparación con individuos sanos para la misma intensidad de ejercicio; sin embargo, a nuestro conocimiento, ningún estudio ha evaluado el RPE en el umbral ventilatorio anaeróbico (VAT) para estas personas. Este estudio tuvo como objetivo evaluar el RPE utilizando la escala Borg CR-10 durante un test de ejercicio cardiopulmonar (CPET) en mujeres con FMS. Veinticuatro mujeres con FMS y veinte individuos de control sanos (HC) participaron voluntariamente en este estudio. Cerca del final de cada período de 1 minuto durante el CPET, se pidió a los individuos que informaran su RPE para la fatiga en los miembros inferiores (RPE-L) y disnea (RPE-D), respectivamente, según la escala Borg CR-10. Los individuos con FMS mostraron mayores RPE-L y RPE-D comparados con los individuos HC en la rueda libre y en el primer incremento de carga. Sin embargo, no se observó diferencia significativa de potencia de salida entre los grupos. No hubo diferencias significativas entre los grupos en los RPE-L y RPE-D reportados en el VAT y en el máximo CPET. No obstante, los individuos FMS mostraron una menor potencia en comparación con los individuos HC. Los resultados actuales mostraron que los individuos con FMS presentan RPE más alto en comparación con los individuos HC. De todos modos, el RPE reportado en el VAT y en el CPET máximo no fue diferente entre los grupos. Las puntuaciones de la escala Borg CR-10 obtenidas en el VAT se pueden utilizarse como un parámetro adicional para prescribir la intensidad del ejercicio en protocolos de entrenamiento aeróbico para mujeres con FMS.

The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients.

Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms. Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). We enrolled 35 women with FMS (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). The electrocardiogram, non-invasive finger blood pressure and respiratory activity were continuously recorded during 15 minutes at rest in supine position (REST) and in orthostatic position during active standing (STAND). Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP→HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain. In conclusion, the lower the degree of cardiac baroreflex involvement during STAND in women with FMS, the higher the impact of FMS on the quality of life, thus suggesting that Granger causality analysis might be clinically helpful in assessing the state of the FMS patient.

Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: a randomized controlled trial.

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 uptake (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, N.=27) or control group (CG, N.=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 CPET, 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.

Lung Function, Respiratory Muscle Strength, and Thoracoabdominal Mobility in Women With Fibromyalgia Syndrome.

BACKGROUND: Fibromyalgia syndrome (FMS) is associated with a variety of symptoms, such as fatigue and dyspnea, which may be related to changes in the respiratory system. The objective of this work was to evaluate pulmonary function, respiratory muscle strength, and thoracoabdominal mobility in women with FMS and its association with clinical manifestations. METHODS: The study included 23 women with FMS and 23 healthy women (control group). Pulmonary function, respiratory muscle strength, and thoracoabdominal mobility were assessed in all participants. Clinical manifestations such as number of active tender points, pain, fatigue, well-being, and general pressure pain threshold and pressure pain threshold in regions involved in respiratory function were also assessed. For data analysis, the Mann-Whitney test and Spearman correlation coefficient were used. RESULTS: The FMS group showed lower values of maximum voluntary ventilation (P = .030), maximal inspiratory pressure (P = .003), and cirtometry at the axillary and xiphoid levels (P < .001 and P < .001, respectively) as well as higher cirtometry at the abdominal level (P = .005) compared with the control group. However, there was no significant difference between groups for maximum expiratory pressure. In predicted percentage, maximal inspiratory pressure showed significant positive correlation with axillary cirtometry (r = 0.41, P = .049) and negative correlation with the number of active tender points (r = -0.44, P = .031) and fatigue (r = -0.41, P = .049). CONCLUSIONS: Subjects with FMS had lower respiratory muscle endurance, inspiratory muscle strength, and thoracic mobility than healthy subjects. In addition, inspiratory muscle strength was associated with the number of active tender points, fatigue, and axillary mobility.

Reliability of heart period and systolic arterial pressure variabilities in women with fibromyalgia syndrome.

The aim of this study is to define absolute and relative reliability of spectral indices of cardiovascular autonomic control in the supine position in women with fibromyalgia syndrome (FMS). Twenty-three women with FMS (age 48 ± 7 years) took part in the study. ECG, finger blood pressure, and respiration were continuously recorded in all participants at rest in baseline 1 (BL1) and after 15 days from BL1 (BL2). The power spectrum analysis provided two oscillatory components: low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.4 Hz) from the heart period (HP) variability and the LF oscillatory component from SAP variability (LFSAP). Absolute and relative reliability were rated by 95 % of the limit of random variation and intraclass correlation coefficient (ICC), respectively. No significant differences were observed between BL1 and BL2 for the spectral indices of HP and SAP variabilities. The 95 % limit of the random variation of these indices indicated that the values of repeated measurements were between 22 % higher and 0.2 % lower (more reliable parameter; average of HP variability) and 912.9 % higher and 0.2 % lower (less reliable parameter; LFSAP) than BL1. Conversely, the index of relative reliability (ICC) ranged from 0.23 to 0.70 indicating a good reliability. The spectral indices of cardiovascular autonomic control in women with FMS seem to present good relative reliability. Therefore, these indices can be useful as parameters to quantify if a variation was consistent and accurate in the retest besides adding crucial information for clinical research and clinical evaluation of FMS patients.

Respiratory Sinus Arrhythmia and its Association with Pain in Women with Fibromyalgia Syndrome.

OBJECTIVES: To assess the cardiac autonomic control at rest and during the deep breathing test (DBT) and its association with pain in women with fibromyalgia syndrome (FMS). METHODS: The study included 20 women with FMS and 20 healthy women (control group, CG). The pain was quantified by assessing the pressure pain threshold (PPT), VAS of pain, and the pain component of the SF-36 questionnaire. The RR intervals were recorded in the supine position and during the DBT. The heart rate variability (VHR) was measured by methods in the time and frequency domain. RESULTS: The group with FMS had abnormal cardiac autonomic modulation at rest and during DBT, compared to CG (P < 0.05). Positive correlations were found between PPT and the E/I ratio (r = 0.70), ΔFC (r = 0.66) and power spectrum density (DEP, r = 0.56) indices of DBT, as well as between pain component of the SF-36 and the E/I ratio (r = 0.49), ΔFC (r = 0.45) and DEP (r = 0.50) indices of DBT. Significant correlations were observed between the FIQ questionnaire and the LF/HF ratio index in the supine position and the E/I ratio (r = -0.63), ΔFC (r = -0.54), and DEP (r = -0.51) indices of DBT. CONCLUSIONS: The results of VHR indices during the supine position and the DBT women with FMS suggest impairment of neurocardiac integrity associated with pain and the impact of FMS on the quality of life.

Cardiovascular control in women with fibromyalgia syndrome: do causal methods provide nonredundant information compared with more traditional approaches?

The cardiovascular autonomic control and the baroreflex sensitivity (BRS) have been widely studied in fibromyalgia syndrome (FMS) patients through the computation of linear indices of spontaneous heart period (HP) and systolic arterial pressure (SAP) variabilities. However, there are many methodological difficulties regarding the quantification of BRS by the traditional indices especially in relation to the issue of causality. This difficulty has been directly tackled via a model-based approach describing the closed-loop HP-SAP interactions and the exogenous influences of respiration. Therefore, we aimed to assess whether the BRS assessed by the model-based causal closed-loop approach during supine and active standing in patients with FMS could provide complementary information to those obtained by traditional indices based on time and frequency domains. The findings of this study revealed that, at difference with the traditional methods to quantify BRS, the causality analysis applied to the HP, SAP, and respiratory series, through the model-based closed-loop approach, detected lower BRS in supine position, as well as a blunted response to the orthostatic stimulus in patients with FMS compared with healthy control subjects. Also, the strength of the causal relation from SAP to HP (i.e., along the cardiac baroreflex) increased during the active standing only in the control subjects. The model-based closed-loop approach proved to provide important complementary information about the cardiovascular autonomic control in patients with FMS.

Effects of a hydrotherapy programme on symbolic and complexity dynamics of heart rate variability and aerobic capacity in fibromyalgia patients.

OBJECTIVES: To evaluate the effects of a hydrotherapy programme on aerobic capacity and linear and non-linear dynamics of heart rate variability (HRV) in women with fibromyalgia syndrome (FMS). METHODS: 20 women with FMS and 20 healthy controls (HC) took part in the study. The FMS group was evaluated at baseline and after a 16-week hydrotherapy programme. All participants underwent cardiopulmonary exercise testing on a cycle ergometer and RR intervals recording in supine and standing positions. The HRV was analysed by linear and non-linear methods. The current level of pain, the tender points, the pressure pain threshold and the impact of FMS on quality of life were assessed. RESULTS: The FMS patients presented higher cardiac sympathetic modulation, lower vagal modulation and lower complexity of HRV in supine position than the HC. Only the HC decreased the complexity indices of HRV during orthostatic stimulus. After a 16-week hydrotherapy programme, the FMS patients increased aerobic capacity, decreased cardiac sympathetic modulation and increased vagal modulation and complexity dynamics of HRV in supine. The FMS patients also improved their cardiac autonomic adjustments to the orthostatic stimulus. Associations between improvements in non-linear dynamics of HRV and improvements in pain and in the impact of FMS on quality of life were found. CONCLUSIONS: A 16-week hydrotherapy programme proved to be effective in ameliorating symptoms, aerobic functional capacity and cardiac autonomic control in FMS patients. Improvements in the non-linear dynamics of HRV were related to improvements in pain and in the impact of FMS on quality of life.

Ratings of perceived exertion at anaerobic threshold in patients with coronary artery disease / Percepción subjetiva del esfuerzo en el liminar anaeróbico en pacientes con enfermedad arterial coronaria / Percepção subjetiva do esforço no limiar anaeróbio em pacientes com doença arterial coronariana

The study aimed to identify and compare the ratings of perceived exertion (RPE) at the ventilatory anaerobic threshold (VAT) in healthy subjects and patients with coronary artery disease (CAD). A total of 30 male subjects took part in the study and were divided into three groups: a control group (CG) composed of 10 healthy participants; a group composed of 10 participants diagnosed with CAD beta-blocker user (G-DACb); and a group composed of 10 participants with CAD non-beta-blocker user (G-DAC). The participants performed a cardiopulmonary exercise test (CPET) with continuous type ramp protocol to determine the VAT, through the visual graphical analysis (loss of parallelism between the oxygen uptake and the carbon dioxide output). During CPET, before the end of each one-minute period, the subjects were asked to rate dyspnea (RPE-D) and leg fatigue (RPE-L) on the Borg CR-10 scale. After the VAT was determined, the score that the participants gave on the Borg CR10 scale was verified. CG participants showed higher workload, oxygen uptake, carbon dioxide output, ventilation and heart rate at the VAT compared to the G-DAC and G-DACb (p<0.05). However, regarding the RPE-L and the RPE-D, no significant difference between the groups were observed (p<0.05). Values between five and six on Borg CR-10 scale matched the VAT in the subjects studied. However, other parameters must be concomitantly used for prescribing exercise intensity in physical training protocols, at levels close to the VAT for patients with CAD.

El objetivo del estudio fue identificar y comparar la percepción subjetiva del esfuerzo (PSE) en el liminar anaeróbico ventilatorio (LAV) en sujetos sanos y con enfermedad arterial coronaria (EAC). Fueron estudiados 30 hombres siendo10 sanos que constituyeron el grupo control (GC) y 20 diagnosticados con EAC, de los cuales 10 utilizaban medicamento betabloqueante (G-DACb) y 10 no utilizaban (G-DAC). Los voluntarios fueron sometidos a una prueba de ejercicio cardiopulmonar (TECP) con protocolo continuo tipo rampa para la determinación del LAV, a través del análisis gráfico visual (pérdida del paralelismo entre el consumo de oxígeno y producción de dióxido de carbono). Durante la realización del TECP, se pidió a los voluntarios que informaran al final de cada minuto la percepción subjetiva del esfuerzo de los miembros inferiores (PSE-M) y la percepción subjetiva del esfuerzo respiratorio (PSE-R) a través de la escala de Borg CR-10. El GC presentó mayores valores de potencia, consumo de oxígeno, producción de dióxido de carbono, ventilación y frecuencia cardiaca en el LAV comparado con los grupos G-DAC y G-DACb (p<0,05). La PSE-M fue menor en el G-DACb comparado con el GC (p<0,05). Después del ajuste por la covariable potencia, no hubo diferencia significativa entre los grupos para PSE-M y PSE-R (p>0,05). Los valores entre cinco y seis en la escala CR-10 de Borg correspondieron al LAV en la muestra estudiada. Sin embargo, otros parámetros deben ser utilizados simultáneamente para la prescripción de la intensidad del ejercicio en los protocolos de entrenamiento físico, en niveles cercanos al LAV para pacientes con EAC.

O objetivo do estudo foi identificar e comparar a percepção subjetiva do esforço (PSE) no limiar anaeróbio ventilatório (LAV) em indivíduos saudáveis e com doença arterial coronariana (DAC). Foram estudados 30 homens, sendo 10 saudáveis que constituíram o grupo controle (GC) e 20 diagnosticados com DAC, dos quais 10 faziam uso de medicamento betabloqueador (G-DACb) e 10 não faziam uso (G-DAC). Os voluntários foram submetidos a um teste de exercício cardiopulmonar (TECP) com protocolo contínuo tipo rampa para determinação do LAV, através da análise visual gráfica (perda do paralelismo entre o consumo de oxigênio e a produção de dióxido de carbono). Durante a realização do TECP, foi solicitado aos voluntários que relatassem ao final de cada minuto a percepção subjetiva do esforço de membros inferiores (PSE-M) e a percepção subjetiva do esforço respiratório (PSE-R), através da escala CR-10 de Borg. O GC apresentou maiores valores de potência, consumo de oxigênio, produção de dióxido de carbono, ventilação e frequência cardíaca no LAV comparado aos grupos G-DAC e G-DACb (p<0,05). A PSE-M foi menor no G-DACb comparado ao GC (p<0,05). Após ajuste pela covariável potência, não houve diferença significativa entre os grupos para PSE-M e PSE-R (p>0,05). Valores entre cinco e seis na escala CR-10 de Borg correspondeu ao LAV na amostra estudada. Entretanto, outros parâmetros devem ser utilizados concomitantemente para a prescrição da intensidade de exercício nos protocolos de treinamento físico, em níveis próximos ao LAV para pacientes com DAC.